Three-dimensional versus two-dimensional laparoscopy: What is the evidence?

Abstract

Background: Minimally invasive surgery has made tremendous progress in the last two decades thanks to the more sophisticated instrumentation, new entry ports, vessel sealant devices, and ultrasound dissectors. Cameras and monitors are now high-definition or 4 K, increasing the clarity of the image available to the surgeon. Those progresses have made minimally invasive surgery safer. However, the biggest challenge of minimally invasive surgery is the lack of depth perception, which requires the surgeon's brain to recreate a three-dimensional (3D) image using cues in the field. The development of 3D cameras enable surgeons to have a more realistic depth perception. The development of the third generation of 3D cameras, combined with light-polarizing glasses, resolved the problem of dizziness experienced by surgeons during long and complicated procedures.

Aims: To review the evidence from human and veterinary surgery regarding the benefits of 3D visualization during laparoscopy.

Conclusions and implications: The evidence suggests that 3D visualization enhances depth perception, safety, a smoother learning curve, and overall wellness for surgeons. Some controversies persist on the clinical benefit of 3D visualization, even if most of the studies showed statistically significant reduction of operating time, estimated blood loss, operating errors, and shorten hospital stay in human patients.

FIGURE 1

Stereoscopic vision: The perception of depth and three‐dimensional structure is obtained on the basis of visual information derived from both eyes by processing the binocular disparities in the visual cortex (courtesy of Sinha et al.⁶).

FIGURE 2

Physics of a three‐dimensional telescope: The telescope has two optical channels that carry two separate images which are fused together to produce a single binocular vision with depth perception (courtesy of Sinha et al.⁶).

FIGURE 3

A three‐dimensional telescope and camera with the two optical channels and light sources (courtesy of Karl Storz Vet Endoscopy).

FIGURE 4

A three‐dimensional (3D) telescope and camera with a control unit and a 3D monitor (courtesy of Karl Storz Vet Endoscopy).

FIGURE 5

Polarizing glasses used with the third generation of three‐dimensional laparoscopy.

FIGURE 6

A three‐dimensional (3D) telescope and camera with a control unit, near‐infrared light, and a 3D monitor used for overlay fluorescent imaging (courtesy of Karl Storz Vet Endoscopy).