Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
Department of Obstetrics and Gynecology, Mamak State Hospital, Ankara, Turkey.
Arch Gynecol Obstet. 2024 Oct;310(4):1811-1821. doi: 10.1007/s00404-024-07630-y. Epub 2024 Aug 24.
To evaluate the existing evidence regarding the comparison between 2 and 3D systems in Total Laparoscopic Hysterectomy (TLH) in terms of surgical outcomes.
A systematic review of electronic databases, including PubMed/MEDLINE and Web of Science, was conducted to identify relevant studies comparing 2D and 3D systems in TLH. The search employed a combination of Medical Subject Headings (MeSH) terms and keywords related to the topic. Studies meeting predefined criteria were included, while case reports and studies not directly comparing 2D and 3D systems were excluded. Two independent reviewers evaluated study eligibility and performed quality assessment. The quantitative synthesis was conducted using meta-analysis techniques.
A statistically significant longer operation time in the 2D group compared to the 3D group (7 studies, mean difference [MD]: 13.67, 95% confidence interval [CI] 9.35-18.00, I = 16%). However, no statistically significant differences were found between the groups in terms of vaginal cuff closure time (2 studies, MD: 3.22, CI - 6.58-13.02, I = 96%), complication rate (7 studies, odds ratio [OD]: 1.74, CI 0.70-4.30, I = 0%), blood loss (3 studies, MD: 2.92, CI - 15.44-21.28, I = 0%), and Hb drop (3 studies, MD: 0.17, CI - 0.08-0.42, I = 1%).
Our results revealed a significant difference favoring 3D systems in operation time, while clinical outcomes between the two systems were found to be comparable in TLH. However, further research, particularly prospective studies with larger cohorts and longer-term follow-up, along with economic analyses, is needed to provide clinicians and healthcare decision-makers with essential guidance for practice and resource allocation.
评估在全腹腔镜子宫切除术（TLH）中，2D 和 3D 系统之间的手术结果比较的现有证据。
对电子数据库（包括 PubMed/MEDLINE 和 Web of Science）进行系统回顾，以确定比较 TLH 中 2D 和 3D 系统的相关研究。搜索采用了与主题相关的医学主题词（MeSH）术语和关键词的组合。纳入符合预定义标准的研究，而排除病例报告和未直接比较 2D 和 3D 系统的研究。两名独立的审查员评估了研究的合格性并进行了质量评估。使用荟萃分析技术进行定量综合。
与 3D 组相比，2D 组的手术时间明显更长（7 项研究，平均差异 [MD]：13.67，95%置信区间 [CI] 9.35-18.00，I = 16%）。然而，两组在阴道残端关闭时间（2 项研究，MD：3.22，CI -6.58-13.02，I = 96%）、并发症发生率（7 项研究，比值比 [OR]：1.74，CI 0.70-4.30，I = 0%）、出血量（3 项研究，MD：2.92，CI -15.44-21.28，I = 0%）和 Hb 下降（3 项研究，MD：0.17，CI -0.08-0.42，I = 1%）方面无统计学差异。
我们的结果表明，3D 系统在手术时间方面具有显著优势，而在 TLH 中，两种系统的临床结果相当。然而，需要进一步的研究，特别是具有更大队列和更长随访时间的前瞻性研究，以及经济分析，以为临床医生和医疗保健决策者提供实践和资源分配的重要指导。
