3D versus 2D laparoscopy for adrenal surgery: an international multicentric retrospective cohort study

Laparoscopy is currently considered the standard of treatment for adrenal lesions but remains a challenging procedure. This retrospective cohort study aims to compare the use of 3D technology with traditional 2D laparoscopy for adrenalectomy through a large, multicentric, international patients' enrollment.

Data of this retrospective cohort study were collected from six high-volume European centers between January 2003 and December 2023. Eligible participants were adults between 18 and 85 years, candidates for laparoscopic adrenal surgery, stratified into two groups: those who underwent three-dimensional laparoscopic adrenalectomy (3D group) versus traditional two-dimensional vision system laparoscopic adrenal surgery (2D group). The incidence of overall complications was estimated and compared between two groups (main endpoint), in addition to comfort vision, surgical depth perception, and surgical strain of the surgical team (secondary endpoint). Other pre-, intra-, and postoperative data were reported as well.

We included 356 patients: 108 (30.34%) underwent traditional laparoscopic surgery, and 248 (69.66%) underwent 3D laparoscopic surgery. The operative time was significantly shorter ( P < 0.001), with an average of 100 minutes for the 3D technique compared to 125.4 minutes for traditional laparoscopy. The conversion rate was 2% in the 3D group versus 7.4% in the 2D group ( P = 0.026). Blood loss was higher in the group treated with traditional laparoscopy (100.7 cc vs. 71.7 cc, P < 0.001), as well as the use of postoperative drainage (68.5% vs. 33.5%, P < 0.001). The postoperative hospital stay was longer for patients treated with the traditional technique, with an average of 4 days (SD = 2.7), compared to an average of 2.8 days (SD = 1.7) for patients treated with the 3D technique ( P < 0.001). Postoperative overall complications were lower in the 3D group, with a 14.1% cumulative incidence of patients experiencing complications, compared to 16% in the traditional laparoscopy group, but not significantly ( P = 0.615). Grade 3b complications, to the Clavien-Dindo classification, were negligible in both the 3D laparoscopic group (0.4%) and the traditional laparoscopic group (0.9%), without any statistically significant difference between the two groups. Based on the subjective assessment of the two techniques, we observed significantly better scores in the 3D procedure versus traditional laparoscopic surgery ( P < 0.001).

The obtained results reinforced the safety and efficacy of the 3D approach. Furthermore, surgeons' positive opinion of 3D laparoscopy is evidence of increased operator comfort and justifies its use in training and clinical practice.