Three-dimensional versus two-dimensional high-definition laparoscopy in cholecystectomy: a prospective randomized controlled study

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Surgical Endoscopy (2019) 33:3725–3731 
https://doi.org/10.1007/s00464-019-06666-5
Three-dimensional versus two-dimensional high-definition 
laparoscopy in cholecystectomy: a prospective randomized controlled 
study
Hanna Koppatz
1
 · Jukka Harju
1
 · Jukka Sirén
1
 · Panu Mentula
1
 · Tom Scheinin
1
 · Ville Sallinen
1,2
 
Received: 19 October 2018 / Accepted: 17 January 2019 / Published online: 1 February 2019 
© The Author(s) 2019
Abstract
Background
While 3D laparoscopy increases surgical performance under laboratory conditions, it is unclear whether it 
improves outcomes in real clinical scenarios. The aim of this trial was to determine whether the 3D laparoscopy can enhance 
surgical efficacy in laparoscopic cholecystectomy (LCC).
Method
This prospective randomized controlled study was conducted between February 2015 and April 2017 in a day case 
unit of an academic teaching hospital. Patients scheduled for elective LCC were assessed for eligibility. The exclusion criteria 
were: (1) planned secondary operation in addition to LCC, (2) predicted to be high-risk for conversion, and (3) surgeons with 
less than five previous 3D laparoscopic procedures. Patients were operated on by 12 residents and 3 attendings. The primary 
endpoint was operation time. All surgeons were tested for stereoaquity (Randot® stereotest). The study was registered in 
ClinicalTrials.gov (NCT02357589).
Results
A total of 210 patients were randomized; 105 to 3D laparoscopy and 104 to 2D laparoscopy. Median operation time 
as similar in the 3D and 2D laparoscopy groups (49 min vs. 48 min, p = 0.703). Operation times were similar in subgroup 
analyses for surgeon’s sex (male vs. female), surgeon’s status (resident vs. attending), surgeon’s stereovision (stereopsis 10 
vs. less than 10), surgeon’s experience (performed 200 LCCs or below versus over 200 LCCs), or patient’s BMI (≤ 25 vs. 
25–30 vs. > 30). No differences in intra- or postoperative complications were noted between the 3D and 2D groups.