Three-Dimensional Versus Two-Dimensional Video-Assisted Endoscopic Surgery: A Meta-analysis of Clinical Data
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There have been no studies to systematically evaluate the two display (3D vs. 2D) systems regarding both laparoscopic and thoracoscopic surgeries in clinical settings; thus, we conducted one to evaluate the safety and efficacy of different visualization systems (two-dimensional and three-dimensional) during endoscopic surgery (laparoscopy or thoracoscopy) in clinical settings.
A comprehensive search of online databases was performed. Perioperative outcomes were synthesized. Cumulative meta-analysis was performed to evaluate the temporal trend of pooled outcomes. Specific subgroups (laparoscopy vs. thoracoscopy, prospective vs. retrospective study, malignant vs. benign diseases) were examined. Meta-regression was conducted to explore the source of heterogeneity.
Twenty-three articles were considered in this analysis, of which 7 were thoracoscopic and 16 were laparoscopic surgeries. A total of 2930 patients were recorded, of which 1367 underwent 3D video-assisted surgery and 1563 underwent 2D display. Overall, significantly shorter operating time (SMD −0.69; p = <0.001), less blood loss (SMD −0.26; p = 0.028) and shorter hospital stays (SMD −0.16; p = 0.016) were found in the 3D display group. Meanwhile, the perioperative morbidity (OR 0.92; p = 0.487), retrieved lymph nodes (SMD 0.09; p = 0.081), drainage duration (SMD −0.15; p = 0.105) and drainage volume (SMD 0.00; p = 0.994) were similar between the two groups. Comparison of the overall outcomes in each subset showed consistency in all groups.
This up-to-date meta-analysis reveals that the 3D display system is superior to the 2D system in clinical settings with significantly shorter operating time, less blood loss and shorter hospital stay. These findings suggest that, in laparoscopic or thoracoscopic surgeries, 3D endoscopic system is preferable when condition permits. Future efforts should be made on decreasing the side effects of 3D display and increasing its cost-effectiveness.
All authors were involved in the conception and design of the study. H-R L and Z-C L contributed to the data acquisition. H-R L, W-H L, Y-H C and Z-C L contributed to the analysis and writing of the manuscript. All authors critically reviewed and approved the final manuscript. We thank Lindsey Hamblin for assistance with the language revision.
This work was supported by the following funding: Science and Technology Planning Project of Guangdong Province, China (Grant Numbers: 2007B031515017; 2008A030201024); Science and Technology Planning Project of Guangzhou, China (Grant Numbers: 2007Z1-E0111; 2007Z3-E0261); and Guangzhou Health and Medical Collaborative Innovative Major Special Projects (Grant No. 201400000001-2)
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Conflict of interest
The authors declare that they have no conflict of interest.
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