Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, P.R. China .
J Endourol. 2018 Sep 12;32(9):781-790. doi: 10.1089/end.2018.0411.
Laparoscopy is widely used in the urological field. This systematic review and a meta-analysis were conducted to assess the clinical and surgical efficacy of the three-dimensional (3D) laparoscopic system in comparison with two-dimensional (2D) laparoscopy for treatment of different urological conditions.
Following guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic literature search in Web of Science, PubMed, Cochrane Library, and EMBase was carried out to identify relevant studies published up to May 2018. Articles published in the English language of both randomized and observational studies comparing 3D and 2D laparoscopic systems in urological surgeries were included. Level of evidence and quality assessments of all included studies were conducted. Interested data were extracted for comparison and meta-analysis.
Our literature search generated 17 studies comparing 3D and 2D laparoscopic systems in different urological surgeries. Of these, 13 studies containing 548 and 449 patients operated on with 2D and 3D laparoscopic systems, respectively, were included for meta-analysis. These 13 studies were divided into three groups according to surgical type. Group 1: Partial nephrectomy (PN); operative time (p = 0.19), estimated blood loss (EBL) (p = 0.51), dissecting time (p = 0.58), and suturing time (p = 0.28) were not statistically significant between 2D and 3D laparoscopic systems. However, warm ischemia time during PN was significantly shorter during 3D laparoscopy (p < 0.00001). Group 2: Pyeloplasty; this procedure showed no significant difference between the two systems. Group 3: Radical prostatectomy (RP); shorter operative time (p < 0.0001) and lower EBL (p = 0.001) were associated with the 3D laparoscopic system.
Three-dimensional laparoscopy mainly improves the depth of perception, leading to better visibility, which is important for some complex urological surgeries such as PN, pyeloplasty, and RP. Based on our findings, 3D laparoscopy seems to provide better clinical and surgical outcomes in some urological procedures compared with conventional 2D laparoscopy.
腹腔镜在泌尿外科领域得到广泛应用。本系统评价和荟萃分析旨在评估三维（3D）腹腔镜系统与二维（2D）腹腔镜相比，在治疗不同泌尿外科疾病方面的临床和手术疗效。
根据系统评价和荟萃分析首选报告项目的指南，我们在 Web of Science、PubMed、Cochrane Library 和 EMBase 中进行了系统文献检索，以确定截至 2018 年 5 月发表的相关研究。纳入了比较泌尿外科手术中 3D 和 2D 腹腔镜系统的英文随机和观察性研究的文章。对所有纳入研究进行了证据水平和质量评估。提取感兴趣的数据进行比较和荟萃分析。
我们的文献检索生成了 17 项比较不同泌尿外科手术中 3D 和 2D 腹腔镜系统的研究。其中，有 13 项研究包含分别接受 2D 和 3D 腹腔镜系统治疗的 548 例和 449 例患者，纳入荟萃分析。这 13 项研究根据手术类型分为三组。第 1 组：部分肾切除术（PN）；手术时间（p=0.19）、估计出血量（EBL）（p=0.51）、解剖时间（p=0.58）和缝合时间（p=0.28）在 2D 和 3D 腹腔镜系统之间无统计学意义。然而，PN 期间的热缺血时间在 3D 腹腔镜下明显缩短（p<0.00001）。第 2 组：肾盂成形术；两种系统之间无显著差异。第 3 组：根治性前列腺切除术（RP）；3D 腹腔镜系统与较短的手术时间（p<0.0001）和较低的 EBL（p=0.001）相关。
3D 腹腔镜主要改善了深度感知，从而提高了可视性，这对于 PN、肾盂成形术和 RP 等一些复杂的泌尿外科手术很重要。根据我们的研究结果，与传统的 2D 腹腔镜相比，3D 腹腔镜在一些泌尿外科手术中似乎提供了更好的临床和手术效果。
