Three-dimensional Laparoscopy (3D-Lc)versusminilaparotomy (MC) in Cholecystectomy: A Prospective Randomized Study

Background/Aim: Three-dimensional laparoscopy (3D-Lap) is a recent innovation in surgery. The 3D-Lap is rarely used in cholecystectomy (3D-LC) and there are no prospective studies assessing advantages and disadvantages of 3D-LC versus minilaparotomy (MC) in cholecystectomy.Patients and Methods: This was a prospective clinical study conducted in the Kuopio University Hospital, including 200 patients with symptomatic cholelithiasis who were randomized into 3D-LC (n=112) or MC (n=88) groups. The numeric rating scale (NRS) pain score and number of analgesic doses (NAD) following surgery were documented.Results: Similar low postoperative pain scores were reported in the 3D-LC and MC groups during the first hours following surgery, although the 3D-LC patients reported lower NRS pain score (p<0.05) one hour postoperatively. Interestingly, the 3D-LC patients showed significantly less pain 24 hours following surgery, the mean of NRS of 0-10 score at rest being 1.2 in the 3D-LC group versus 2.2 in the MC group (p<0.001), and the pain at the quick movement/coughing, the mean NRS being 2.9 in the 3D-LC group versus 3.6 in the MC group (p=0.05). Conclusion: The 3D-LC patients reported significantly lower pain scores 24 hours postoperatively than MC patients. However, the patient experience of pain depends on many factors and our results suggest that both 3D-LC and MC are safe and efficient techniques for cholecystectomy. Two-dimensional laparoscopic cholecystectomy (2D-LC) is the gold-standard operative technique for the treatment of symptomatic cholelithiasis (1-3). The minilaparotomy cholecystectomy (MC) technique is a feasible and safe option currently in use, because of the simple instrumentation used and reasonable costs (2, 3). Three- dimensional laparoscopy (3D-lap) is the latest development in laparoscopic surgery and has been shown to enhance surgical efficacy, diminish errors, increase spatial awareness, and reduce time to complete surgical tasks in laboratory settings (4, 5). Recently, certain clinical studies investigated whether the advantages of 3D-lap found in laboratory are transferable to the clinical environment (3, 6-8). These studies have presented conflicting results; some report benefits for 3D-lap (6-8), while others did not find advantages of 3D-lap over conventional 2D-lap (3, 9). The 3D-lap is uncommon in cholecystectomy (3D-LC) and there are no earlier studies assessing 3D-LC versus MC in cholecystectomy. The aim of our study was to assess whether the 3D-LC technique could enhance the patient satisfaction with lower pain scale in comparison to the MC procedure