Komaei Iman, Navarra Giuseppe, Currò Giuseppe
Surgical Oncology Unit, Department of Human Pathology of Adult and Evolutive Age, University Hospital of Messina , Messina, Italy .
J Laparoendosc Adv Surg Tech A. 2017 Aug;27(8):790-794. doi: 10.1089/lap.2017.0155. Epub 2017 Jun 8.
In the last decades, the three-dimensional (3D) imaging systems have been introduced in an attempt to improve depth perception and image quality during laparoscopic cholecystectomy interventions. The goal of our systematic review was to provide enough convincing evidences on superiority and benefits of 3D over two-dimensional (2D) imaging systems, from both surgeon's and patient's point of view, justifying the cost-effectiveness of newly developed 3D systems.
Two authors separately performed a full literature search aiming to find randomized controlled trials evaluating the advantages and disadvantages of 3D versus 2D laparoscopic cholecystectomy procedures. The patients who underwent elective laparoscopic cholecystectomy were included in this study irrespective of their age and sex. Differing opinions between the two authors were reviewed by the third author.
A total of 912 articles were initially reviewed by their titles and abstracts for eligibility. After being filtered through predetermined inclusion and exclusion criteria, and excluding the duplicates, only 10 studies underwent the final evaluation by the full text assessment. Eventually, only five randomized controlled studies were included in this study. Operative time and depth perception/image quality were set as the primary and secondary outcomes, respectively. The operative time was significantly shorter in 60% of the studies. Of five studies that evaluated the depth perception and image quality, all five (100%) reported a better depth perception and image quality.
3D imaging systems tend to shorten the operative time compared to 2D systems and result in a better depth perception. More studies and investigations with bigger cohort sizes and using unique 3D visual systems are necessary to justify the cost-effectiveness of the new, more expensive 3D systems.
在过去几十年中，三维（3D）成像系统已被引入，旨在改善腹腔镜胆囊切除术干预过程中的深度感知和图像质量。我们系统评价的目的是从外科医生和患者的角度，提供足够有说服力的证据，证明3D成像系统相对于二维（2D）成像系统的优越性和益处，从而证明新开发的3D系统的成本效益。
两位作者分别进行了全面的文献检索，旨在寻找评估3D与2D腹腔镜胆囊切除术优缺点的随机对照试验。接受择期腹腔镜胆囊切除术的患者，无论年龄和性别，均纳入本研究。两位作者之间的不同意见由第三位作者进行审查。
最初通过标题和摘要对总共912篇文章进行了资格审查。经过预先确定的纳入和排除标准筛选，并排除重复项后，只有10项研究通过全文评估进行了最终评价。最终，本研究仅纳入了5项随机对照研究。手术时间和深度感知/图像质量分别被设定为主要和次要结局。60%的研究中手术时间显著缩短。在评估深度感知和图像质量的5项研究中，所有5项（100%）均报告深度感知和图像质量更好。
与2D系统相比，3D成像系统往往能缩短手术时间，并带来更好的深度感知。需要更多的研究和调查，纳入更大的队列规模，并使用独特的3D视觉系统，以证明新的、更昂贵的3D系统的成本效益。
