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

Abstract

Objectives

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

Methods

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.

Results

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.

Conclusions

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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Author information

Affiliations

Authors

Contributions

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.

Corresponding author

Correspondence to Shahin Hajibandeh.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

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

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Appendix

Appendix

Table 1 Search strategy

Search no.Search strategy*
#1MeSH descriptor: [cholecystectomy] explode all trees
#2cholecystectomy: TI,AB,KW
#3MeSH descriptor: [Laparoscopic cholecystectomy] explode all trees
#4Laparoscopic cholecystectomy: TI,AB,KW
#5#1 OR #2 OR #3 OR #4
#6MeSH descriptor: [3 dimensional ] explode all trees
#73 dimensional : TI,AB,KW
#8MeSH descriptor: [3D ] explode all trees
#93D : TI,AB,KW
#10MeSH descriptor: [2 dimensional ] explode all trees
#112 dimensional : TI,AB,KW
#12MeSH descriptor: [2D] explode all trees
#132D : TI,AB,KW
#14MeSH descriptor: [three-dimensional] explode all trees
#15three-dimensional : TI,AB,KW
#16MeSH descriptor: [ two-dimensional ] explode all trees
#17two-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 (2020). https://doi.org/10.1007/s00423-020-01909-9

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Keywords

  • Three-dimensional
  • Two-dimensional
  • Laparoscopic cholecystectomy