Clinical Research Papers:
Two-dimensional versus three-dimensional laparoscopy in surgical efficacy: a systematic review and meta-analysis
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Ji Cheng1, Jinbo Gao1, Xiaoming Shuai1, Guobin Wang1 and Kaixiong Tao1
1 Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
Kaixiong Tao, email:
Keywords: three-dimensional laparoscopy; two-dimensional laparoscopy; surgical efficacy; systematic review; meta-analysis
Received: April 15, 2016 Accepted: June 30, 2016 Published: July 29, 2016
Background: Laparoscopy is a revolutionary technique in modern surgery. However, the comparative efficacy between two-dimensional laparoscopy and three-dimensional laparoscopy remains in uncertainty. Therefore we performed this systematic review and meta-analysis in order to seek for answers.
Methods: Databases of PubMed, Web of Science, EMBASE and Cochrane Library were carefully screened. Clinical trials comparing two-dimensional versus three-dimensional laparoscopy were included for pooled analysis. Observational and randomized trials were methodologically appraised by Newcastle-Ottawa Scale and Revised Jadad’s Scale respectively. Subgroup analyses were additionally conducted to clarify the potential confounding elements. Outcome stability was examined by sensitivity analysis, and publication bias was analyzed by Begg’s test and Egger’s test.
Results: 21 trials were screened out from the preliminary 3126 records. All included studies were high-quality in methodology, except for Bilgen 2013 and Ruan 2015. Three-dimensional laparoscopy was superior to two-dimensional laparoscopy in terms of surgical time (P < 0.00001), blood loss (P = 0.01), perioperative complications (P = 0.04) and hospital stay (P = 0.03). Additionally, both techniques demonstrated comparable results of secondary endpoints, including drainage volume (P = 0.74), drainage time (P = 0.26), numbers of retrieved lymphnodes (P = 0.85), hospital expenses (P = 0.49), anastomosis time in prostatectomy (P=0.15) and 6-month continence rate (P = 0.61). The pooled outcomes of primary endopoints were verified to be stable by sensitivity analysis. Although Begg’s test (P = 0.215) and Egger’s test (P = 0.003) revealed that there was publication bias across included studies, Trim-and-Fill method confirmed that the results remained stable.
Conclusion: Three-dimensional laparoscopy is a preferably surgical option against two-dimensional laparoscopy due to its better surgical efficacy.
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