Three-dimensional versus two-dimensional high-definition laparoscopy in cholecystectomy: a prospective randomized controlled study

Abstract

BackgroundWhile 3D laparoscopy increases surgical performance under laboratory conditions, it is unclear whether it improves outcomes in real clinical scenarios. The aim of this trial was to determine whether the 3D laparoscopy can enhance surgical efficacy in laparoscopic cholecystectomy (LCC).MethodThis prospective randomized controlled study was conducted between February 2015 and April 2017 in a day case unit of an academic teaching hospital. Patients scheduled for elective LCC were assessed for eligibility. The exclusion criteria were: (1) planned secondary operation in addition to LCC, (2) predicted to be high-risk for conversion, and (3) surgeons with less than five previous 3D laparoscopic procedures. Patients were operated on by 12 residents and 3 attendings. The primary endpoint was operation time. All surgeons were tested for stereoaquity (Randot® stereotest). The study was registered in ClinicalTrials.gov (NCT02357589).ResultsA total of 210 patients were randomized; 105 to 3D laparoscopy and 104 to 2D laparoscopy. Median operation time as similar in the 3D and 2D laparoscopy groups (49 min vs. 48 min, p = 0.703). Operation times were similar in subgroup analyses for surgeon’s sex (male vs. female), surgeon’s status (resident vs. attending), surgeon’s stereovision (stereopsis 10 vs. less than 10), surgeon’s experience (performed 200 LCCs or below versus over 200 LCCs), or patient’s BMI (≤ 25 vs. 25–30 vs. > 30). No differences in intra- or postoperative complications were noted between the 3D and 2D groups.Conclusion3D laparoscopy did not show any advantages over 2D laparoscopy in LCC.

3D laparoscopy does not reduce operative duration or errors in day-case laparoscopic cholecystectomy: a randomised controlled trial

“…Our findings, which could be expected to be widely applicable, are comparable with the original 1998 and very recent 2D/3D LC RCT reports although our notable absence of subjectively reported side effects and eye symptoms suggests contemporary 3D technology holds improved usability [24,26]. Our data suggests specialist LC performance was not altered by the technology used, possibly as the participating surgeon experience allowed them to overcome the loss of depth perception.…”

Assessment of 3-Dimensional vs 2-Dimensional Imaging and Technical Performance Using a Multiport Intraoperative Data Capture and Analytic System for Patients Undergoing Laparoscopic Roux-en-Y Gastric Bypass Surgery

“…16 Other studies 28,36,37 have shown technical improvement using 3-D laparoscopic systems, but the results have been inconsistent. A prospective, randomized clinical trial 16 The total number of error-related events was significantly lower when the 3-D system was used;…”

“…In laparoscopic cases, a substantial number of these events are associated with depth perception, as evidenced by a study that evaluated 252 cases of laparoscopic cholecystectomy, in which 97% of surgical accidents occurred as a result of visual misperceptions. [13][14][15][16] In the past 20 years, the advancement of laparoscopic technology has led to increased safety, better precision, and improved efficiency in the OR, but the lack of depth perception when using traditional 2-dimensional (2-D) laparoscopic systems remains a major limitation. 17 Three-dimensional laparoscopic systems provide direct stereoscopic depth, which may improve operative speed and technical performance in laparoscopic procedures.…”

Is 3D faster and safer than 4K laparoscopic cholecystectomy? A randomised-controlled trial

“…However, these were smaller studies with less statistical power. Koppatz et al recently reported the largest 3D HD versus 2D HD laparoscopic cholecystectomy study to date, with over 100 participants in each arm [22]. They showed no difference in operative times or complication rates between 3D and 2D, including on subgroup analysis for surgical experience.…”