Three-dimensional versus two-dimensional video-assisted thoracic surgery for thoracic disease: a meta-analysis

It remains unclear whether 3D systems are manoeuvrable in video-assisted thoracic surgery (VATS) for patients with thoracic diseases. The objective of this systematic review and meta-analysis was to evaluate the efficacy and safety of 3D VATS compared with 2D VATS.

A systemic research of the literature was performed using the PubMed, Embase, the Cochrane library, China National Knowledge Infrastructure, Wanfang and CQVIP databases through December 2016. Studies investigating the efficacy and safety of 3D VATS compared with 2D VATS were eligible for our meta-analysis. Odds ratios and mean differences or standard mean differences with 95% confidence intervals (95% CI) as well as a P-value were applied to compare continuous and dichotomous variables, respectively.

Seven studies with 1080 patients (525 patients for 3D VATS and 555 patients for 2D VATS) were included. There were significant differences in the 3D group with regard to shorter operation times (standard mean difference = -0.66, 95% CI: -0.98 to - 0.34; P < 0.001), less blood loss (mean difference = -12.12, 95% CI: -19.07 to - 5.16; P < 0.001) and shorter postoperative drainage times (standard mean difference = -0.53, 95% CI: -0.92 to - 0.14; P = 0.008) compared with the 2D group. However, no statistical difference was found for postoperative hospital stay, total postoperative drainage volume, postoperative drainage volume in 24 h, number of lymph nodes dissected and postoperative complications.

The results of this systematic review and meta-analysis suggest that 3D VATS might be an acceptable method for treating thoracic diseases in the future.