Solanki Smit Bharat, Mishra Vineet V, Dhiman Arminder Singh
From the Department of Obstetrics and Gynecology, Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Ahmedabad, India.
From the Department of Obstetrics and Gynecology, Apollo Hospitals Ahmedabad, Gandhinagar, India.
Ann Saudi Med. 2025 Jul-Aug;45(4):243-248. doi: 10.5144/0256-4947.2025.243. Epub 2025 Aug 7.
Three-dimensional (3D) high-definition (HD) laparoscopy is a promising tool in minimally invasive gynecologic surgery, offering enhanced depth perception and visualization. However, its role in total laparoscopic hysterectomy (TLH), particularly in patients with varying body mass index (BMI), remains underexplored.
To evaluate the impact of 3D HD laparoscopy on surgical efficiency and patient outcomes in TLH, with a focus on BMI-related differences.
A single-center retrospective study.
Sixty patients who underwent TLH were included: n=30 used 3D HD laparoscopy (Aesculap 3D EinsteinVision) and n=30 matched controls used 2D laparoscopy. Matching criteria included uterine weight and prior surgical history. Patients were stratified according to BMI (≤24.9, 25-29.9, ≥30.0 kg/m).
Operative time, vault suturing time, blood loss, trocar site incisions, haemoglobin drop, and complication rates.
60 patients (30 in each group).
The 3D HD laparoscopy group demonstrated significant improvements across multiple outcomes. Trocar site incisions were significantly reduced in all BMI categories ( <.001). Vault suturing time was shorter in the 3D HD laparoscopy group ( =.002), and total operative time was reduced in overweight patients ( =.015). Obese patients in the 3D group had lower haemoglobin drop ( =.01) and reduced blood loss compared to 2D laparoscopy group ( =.017).
3D HD laparoscopy enhances surgical efficiency in TLH, especially in patients with higher BMI, by minimizing trocar site incisions, reducing vault suturing times, and improving hemostasis-highlighting its value in overcoming challenges of minimally invasive gynecologic surgery.
The study's retrospective design and modest sample size limit generalizability.
三维（3D）高清（HD）腹腔镜检查是微创妇科手术中一种很有前景的工具，能提供增强的深度感知和可视化效果。然而，其在全腹腔镜子宫切除术（TLH）中的作用，尤其是在不同体重指数（BMI）患者中的作用，仍未得到充分探索。
评估3D HD腹腔镜检查对TLH手术效率和患者结局的影响，重点关注与BMI相关的差异。
单中心回顾性研究。
纳入60例行TLH的患者：30例使用3D HD腹腔镜检查（蛇牌3D爱因斯坦视觉系统），30例匹配的对照组使用二维腹腔镜检查。匹配标准包括子宫重量和既往手术史。患者根据BMI分层（≤24.9、25 - 29.9、≥30.0 kg/m²）。
手术时间、阴道顶端缝合时间、失血量、穿刺孔切口、血红蛋白下降情况及并发症发生率。
60例患者（每组30例）。
3D HD腹腔镜检查组在多个结局指标上有显著改善。所有BMI类别中的穿刺孔切口均显著减少（P <.001）。3D HD腹腔镜检查组的阴道顶端缝合时间更短（P =.002），超重患者的总手术时间减少（P =.015）。与二维腹腔镜检查组相比，3D组的肥胖患者血红蛋白下降幅度更低（P =.01）且失血量减少（P =.017）。
3D HD腹腔镜检查通过减少穿刺孔切口、缩短阴道顶端缝合时间和改善止血，提高了TLH的手术效率，尤其是在BMI较高的患者中，凸显了其在克服微创妇科手术挑战方面的价值。
该研究的回顾性设计和样本量有限限制了其普遍性。
