Three-dimensional versus two-dimensional imaging during laparoscopic cholecystectomy: a systematic review and meta-analy
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SYSTEMATIC REVIEWS AND META-ANALYSES
Three-dimensional versus two-dimensional imaging during laparoscopic cholecystectomy: a systematic review and meta-analysis of randomised controlled trials Sian Davies 1 & Mohammed Ghallab 2 & Shahab Hajibandeh 3 & Shahin Hajibandeh 4
&
Sarah Addison 5
Received: 8 May 2020 / Accepted: 12 June 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objectives To evaluate the comparative outcomes of three-dimensional (3D) versus two-dimensional (2D) imaging during laparoscopic cholecystectomy. Methods We conducted a systematic search of electronic information sources and bibliographic reference lists and applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits. Procedure time, Calot’s triangle dissection time, gallbladder removal time, gallbladder perforation, intraoperative bleeding, postoperative complications, conversion to open and intraoperative errors were the evaluated outcome parameters. Results We identified 6 randomised controlled trials (RCT) reporting a total of 577 patients who underwent laparoscopic cholecystectomy using 3D (n = 282) or 2D (n = 295) imaging. The 3D imaging was associated with significantly shorter procedure time (MD − 4.23, 95% CI − 8.14 to − 0.32, p = 0.03), Calot’s triangle dissection time (MD − 4.19, 95% CI − 6.52 to − 1.86, p = 0.0004) and significantly lower risk of gallbladder perforation (RR 0.50, 95% CI 0.28–0.88, p = 0.02) compared to the 2D approach. No significant difference was found in gallbladder removal time (MD − 0.79, 95% CI − 2.24 to 0.66, p = 0.28), intraoperative bleeding (RR 1.14, 95% CI 0.68–1.90, p = 0.61), postoperative complications (RD − 0.01, 95% CI − 0.06 to 0.05, p = 0.85), conversion to open (RD 0.00, 95% CI − 0.02 to 0.03, p = 0.70) or intraoperative errors (RR 0.96, 95% CI 0.79–1.17, p = 0.70) between the two groups. Conclusions Although our findings suggest that the use of 3D imaging during laparoscopic cholecystectomy may be associated with significantly shorter procedure time, Calot’s triangle dissection time and gallbladder injury compared to the 2D imaging, the differences seem to be clinically insignificant. Moreover, both approaches carry s similar risk of postoperative morbidities. The impact of the surgeon’s level of experience and difficulty of the procedure on the outcomes of each imaging modality remains unknown. Keywords Three-dimensional . Two-dimensional . Laparoscopic cholecystectomy Sian Davies and Mohammed Ghallab equally contributed to this paper and joint first authorship is proposed. * Shahin Hajibandeh [email protected] 1
Department of General Surgery, The Shrewsbury and Telford Hospital NHS Trust, Telford, UK
2
Department of Hepato-Pancreato-Biliary and Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
3
Department of General Surgery, Glan Clwyd Hospital, Rhyl, Denbighshire, UK
4
Department of General Surgery, Sandwell and West Birmingham Hospitals
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