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Three-dimensional versus two-dimensional imaging during laparoscopic cholecystectomy: a systematic review and meta-analysis of randomised controlled trials



To evaluate the comparative outcomes of three-dimensional (3D) versus two-dimensional (2D) imaging during laparoscopic cholecystectomy.


We conducted a systematic search of electronic information sources and bibliographic reference lists and applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits. Procedure time, Calot’s triangle dissection time, gallbladder removal time, gallbladder perforation, intraoperative bleeding, postoperative complications, conversion to open and intraoperative errors were the evaluated outcome parameters.


We identified 6 randomised controlled trials (RCT) reporting a total of 577 patients who underwent laparoscopic cholecystectomy using 3D (n = 282) or 2D (n = 295) imaging. The 3D imaging was associated with significantly shorter procedure time (MD − 4.23, 95% CI − 8.14 to − 0.32, p = 0.03), Calot’s triangle dissection time (MD − 4.19, 95% CI − 6.52 to − 1.86, p = 0.0004) and significantly lower risk of gallbladder perforation (RR 0.50, 95% CI 0.28–0.88, p = 0.02) compared to the 2D approach. No significant difference was found in gallbladder removal time (MD − 0.79, 95% CI − 2.24 to 0.66, p = 0.28), intraoperative bleeding (RR 1.14, 95% CI 0.68–1.90, p = 0.61), postoperative complications (RD − 0.01, 95% CI − 0.06 to 0.05, p = 0.85), conversion to open (RD 0.00, 95% CI − 0.02 to 0.03, p = 0.70) or intraoperative errors (RR 0.96, 95% CI 0.79–1.17, p = 0.70) between the two groups.


Although our findings suggest that the use of 3D imaging during laparoscopic cholecystectomy may be associated with significantly shorter procedure time, Calot’s triangle dissection time and gallbladder injury compared to the 2D imaging, the differences seem to be clinically insignificant. Moreover, both approaches carry s similar risk of postoperative morbidities. The impact of the surgeon’s level of experience and difficulty of the procedure on the outcomes of each imaging modality remains unknown.

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Authors and Affiliations



Conception and design: Shahin H. Literature search and study selection: SD and MG. Data collection: SD, MG, Shahab H and Shahin H. Analysis and interpretation: Shahin H and Shahab H. Writing the article: SD, MG and Shahin H. Critical revision of the article: all authors. Final approval of the article: all authors. Statistical analysis: Shahin H and Shahab H.

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Correspondence to Shahin Hajibandeh.

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Considering the design of our study, ethical approval and consent were not required.

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Table 1 Search strategy

Search no. Search strategy*
#1 MeSH descriptor: [cholecystectomy] explode all trees
#2 cholecystectomy: TI,AB,KW
#3 MeSH descriptor: [Laparoscopic cholecystectomy] explode all trees
#4 Laparoscopic cholecystectomy: TI,AB,KW
#5 #1 OR #2 OR #3 OR #4
#6 MeSH descriptor: [3 dimensional ] explode all trees
#7 3 dimensional : TI,AB,KW
#8 MeSH descriptor: [3D ] explode all trees
#9 3D : TI,AB,KW
#10 MeSH descriptor: [2 dimensional ] explode all trees
#11 2 dimensional : TI,AB,KW
#12 MeSH descriptor: [2D] explode all trees
#13 2D : TI,AB,KW
#14 MeSH descriptor: [three-dimensional] explode all trees
#15 three-dimensional : TI,AB,KW
#16 MeSH descriptor: [ two-dimensional ] explode all trees
#17 two-dimensional : TI,AB,KW
#18 #6 OR #7 OR #8 OR #9 #10 OR #11 OR #12 OR #13 #14 OR #15 OR #16 OR #17
#19 #5 AND #18
  1. *This search strategy was adopted for following databases: MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL)

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Davies, S., Ghallab, M., Hajibandeh, S. et al. Three-dimensional versus two-dimensional imaging during laparoscopic cholecystectomy: a systematic review and meta-analysis of randomised controlled trials. Langenbecks Arch Surg 405, 563–572 (2020).

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  • Three-dimensional
  • Two-dimensional
  • Laparoscopic cholecystectomy