Comparative study of the influence of 3D versus 2D urological laparoscopy on surgeons' surgical performance and ergonomics: A systematic review and meta-analysis.

The objective of this study is to compare the use of three-dimensional (3D) vision systems with traditional two-dimensional (2D) systems in laparoscopic urological surgery, analyzing the benefits, limitations and impact of introducing this medical technology with regard to surgical performance and the surgeon's ergonomics.

A systematic review with a structured bibliographic search was conducted in the electronic libraries (PubMed and EMBASE) until August 2019 and with no language restrictions. Studies on 3D visualization technology in laparoscopic urologic surgery, randomized controlled trials and observational comparative studies were included. Relevant data were extracted and analyzed.

A total of 25 articles were obtained, of which 4 were clinical studies with patients, 2 studies were carried out in experimental animal models and the remaining 19 were conducted in simulated environments. Regarding the European training program in basic laparoscopic urological skills (E-BLUS), the results showed no significant differences in execution time using either imaging system. 3D vision led to a significant reduction in surgery time in pyeloplasty and radical nephrectomy. In addition, there was a reported decrease in blood loss in adrenalectomy, nephron-sparing nephrectomy, radical nephrectomy, simple nephrectomy and pyeloplasty using 3D vision. Regarding ergonomics, the studies generally described no differences in side effects (headache, nausea, eye strain) when comparing the two types of visualization systems. Surgeons reported reduced workloads and stress with 3D vision than with traditional laparoscopy.

Three-dimensional laparoscopic systems essentially advance surgical performance in less experienced laparoscopic surgeons. Three-dimensional laparoscopy leads to improvements in surgery time, which is important for specific surgical procedures involving intracorporeal ligatures and sutures. The results achieved on the surgeons' ergonomics showed better depth perception and decreased stress and workloads during 3D vision with no differences in potential side effects.

Journal of endourology. 2020 Aug 16 [Epub ahead of print]

Francisco Miguel Sanchez Margallo, David Durán Rey, Alvaro Serrano, Julio Mayol Martínez, Juan A Sánchez Margallo

Jesus Uson Minimally Invasive Surgical Centre, 203339, Scientific Director, Ctra. N-521, km 41,8, Caceres, Spain, 10071; ., Jesus Uson Minimally Invasive Surgical Centre, 203339, Laparoscopy, Caceres, Cáceres, Spain; ., Hospital Clínico San Carlos, 16267, Urology Department, Madrid, Madrid, Spain; ., Hospital Clínico San Carlos, 16267, Surgery, Madrid, Madrid, Spain; ., Jesus Uson Minimally Invasive Surgical Centre, 203339, Bioengineering, Caceres, Cáceres, Spain; .