Comparison of 2D and 3D visualization in minimally invasive and robotic surgery: a systematic review

Minimally invasive surgery (MIS) has transformed abdominal surgery by improving recovery times and maintaining comparable outcomes to open surgery. However, the loss of three-dimensional (3D) visualization remains a limitation. Robotic platforms have facilitated the adoption of 3D systems. Despite these developments, the advantages of 3D over two-dimensional (2D) visualization in MIS and robotic surgery remain controversial.

A systematic review was conducted including studies published between January 2015 and May 2024. Studies comparing 2D and 3D visualization in MIS and robotic surgery were included. Primary outcomes assessed were operative time, intraoperative blood loss, length of stay, conversion and complication rates.

Regarding MIS, three studies demonstrated a statistically significant reduction in blood loss favoring 3D visualization, with median reductions from 60 mL (IQR 20-60) to 20 mL (IQR 5-40) (p = 0.008). Operative time was significantly reduced in 15 studies, notably in hernia repairs, bariatric, gastric, and colorectal surgeries. Two studies reported marginally significant reductions in hospital stay. Complication rates showed isolated improvements. In robotic surgery, 14 studies showed 3D visualization enhanced task performance, with tasks completed up to 88% faster among novice surgeons.

3D visualization consistently reduces operative time in selected MIS procedures and improves robotic task performance, whereas effects on blood loss, complications, and length of stay are inconsistent. Standardized, procedure-specific trials-especially against 2D-4K-and reporting of clinical outcomes in robotic surgery are needed.