Three-dimensional versus two-dimensional vision in laparoscopy: a systematic review
Laparoscopic surgery is widely used, and results in accelerated patient recovery time and hospital stay were compared with laparotomy. However, laparoscopic surgery is more challenging compared with open surgery, in part because surgeons must operate in a three-dimensional (3D) space through a two-dimensional (2D) projection on a monitor, which results in loss of depth perception. To counter this problem, 3D imaging for laparoscopy was developed. A systematic review of the literature was performed to assess the effect of 3D laparoscopy.
A systematic search of the literature was conducted to identify randomized controlled trials that compared 3D with 2D laparoscopy. The search was accomplished in accordance with the PRISMA guidelines using the PubMed, EMBASE, and The Cochrane Library electronic databases. No language or year of publication restrictions was applied. Data extracted were cohort size and characteristics, skill trained or operation performed, instrument used, outcome measures, and conclusions. Two independent authors performed the search and data extraction.
Three hundred and forty articles were screened for eligibility, and 31 RCTs were included in the review. Three trials were carried out in a clinical setting, and 28 trials used a simulated setting. Time was used as an outcome measure in all of the trials, and number of errors was used in 19 out of 31 trials. Twenty-two out of 31 trials (71 %) showed a reduction in performance time, and 12 out of 19 (63 %) showed a significant reduction in error when using 3D compared to 2D.
Overall, 3D laparoscopy appears to improve speed and reduce the number of performance errors when compared to 2D laparoscopy. Most studies to date assessed 3D laparoscopy in simulated settings, and the impact of 3D laparoscopy on clinical outcomes has yet to be examined.
KeywordsLaparoscopy Three-dimensional imaging Laparoscopic training Surgical skills Three-dimensional laparoscopy
We thank Henrik Hornemann, instruction and reference librarian, the Royal Library/KUBIS, Denmark, for his assistance with developing the search string.
Stine Maya Dreier Sørensen, Mona Meral Savran, Lars Konge, and Flemming Bjerrum have no conflict of interest or financial ties to disclose.
- 6.Wilhelm D, Reiser S, Kohn N, Witte M, Leiner U, Mühlbach L, Ruschin D, Reiner W, Feussner H (2014) Comparative evaluation of HD 2D/3D laparoscopic monitors and benchmarking to a theoretically ideal 3D pseudodisplay: even well-experienced laparoscopists perform better with 3D. Surg Endosc 28(8):2387–2397PubMedCrossRefGoogle Scholar
- 11.Kihara K, Fujii Y, Masuda H, Saito K, Koga F, Matsuoka Y, Numao N, Kojima K (2012) New three-dimensional head-mounted display system, TMDU-S-3D system, for minimally invasive surgery application: procedures for gasless single-port radical nephrectomy. Int J Urol 19(9):886–889PubMedCrossRefGoogle Scholar
- 14.Cicione A, Autorino R, Breda A, Sio MD, Damiano R, Fusco F, Greco F, Carvalho-Dias E, Mota P, Nogueira C, Pinho P, Mirone V, Correia-Pinto J, Rassweiler J, Lima E (2013) Three-dimensional vs standard laparoscopy: comparative assessment using a validated program for laparoscopic urologic skills. Urology 82(6):1444–1450PubMedCrossRefGoogle Scholar
- 15.Alaraimi B, Bakbak W, Sarker S, Makkiyah S, Al-Marzouq A, Goriparthi R, Bouhelal A, Quan V, Patel B (2014) A randomized prospective study comparing acquisition of laparoscopic skills in three-dimensional (3D) vs. two-dimensional (2D) laparoscopy. World J Surg 38(11):2746–2752PubMedCrossRefGoogle Scholar
- 16.Gurusamy KS, Sahay S, Davidson BR (2011) Three dimensional versus two dimensional imaging for laparoscopic cholecystectomy. Cochrane Database Syst Rev 19(1):CD006882Google Scholar