Laparoscopic Appendectomy Performed by junior SUrgeonS: impact of 3D visualization on surgical outcome. Randomized multicentre clinical trial. (LAPSUS TRIAL)



The purpose of this study was to evaluate the effect of 3D visualization applied to laparoscopic appendectomy (LA) performed by young surgeons (YS). We considered both operative features and clinical outcomes, aiming to highlight the benefits that this technology could bring to novice surgeons and their laparoscopic training.


All the surgical procedures were performed by residents who had performed less than 20 appendectomies prior to the beginning of the study under the supervision of an expert surgeon. At the time of enrolment patients were randomized into two arms: Experimental arm (EA): laparoscopic appendectomy performed with laparoscopic 3D vision technology. Control arm (CA): laparoscopic appendectomy performed with the "standard" 2D technology. The primary endpoint was to find any statistically significant difference in operative time between the two arms. Differences in conversion rate, intra-operative complications, post-operative complications and surgeons’ operative comfort were considered as secondary endpoints.


We randomized 135 patients into the two study arms. The two groups were homogeneous for demographic characteristics, BMI and ASA scores. The characteristics of clinical presentation and anatomical position showed no significant difference. The operative time was longer in the CA (57.5 vs. 49.6 min, p = 0.048, 95% CI). In the subgroup of complicated appendicitis, this trend toward inferior operative time was confirmed without reaching statistical significance (2D = 60 min, 3D = 49.5 min, p = 0.082 95% CI).

No intra-operative complications were observed in either group. The conversion rate was 5.6% (4 patients) in the 2D group and 4.6% (3 patients) in 3D group.


The utilization of 3D laparoscopy was associated with reduction in operative time without influencing other parameters, in particular without altering the safety profile of the procedure.

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Correspondence to E. Botteri.

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Drs Emanule Botteri, Monica Ortenzi, Giovanni Alemanno, Alessio Giordano, Elisabetta Travaglio, Cecilia Turolo, Simone Castiglioni, Elio Treppiedi, Edoardo Rosso, Andrea Gattolin, Valerio Caracino, Paolo Prosperi, Andrea Valeri, Mario Guerrieri and Nereo Vettoretto have no conflicts of interest or financial ties to disclose.

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Botteri, E., Ortenzi, M., Alemanno, G. et al. Laparoscopic Appendectomy Performed by junior SUrgeonS: impact of 3D visualization on surgical outcome. Randomized multicentre clinical trial. (LAPSUS TRIAL). Surg Endosc 35, 710–717 (2021).

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  • Laparoscopic appendectomy
  • 3D laparoscopy
  • Young surgeons
  • Laparoscopic training
  • 3D technology