A Prospective Randomized Controlled Study Comparing Three-dimensional and Two-dimensional Laparoscopic Cholecystectomy: Operative Efficiency and Safety

Chalermpol  Boonpromteerakul; Satchachon  Changthom; Thanissara Namboonruang

doi:10.64960/srimedj.v41i5.271438

Authors

Chalermpol Boonpromteerakul Department of Surgery, MahasarakhamHospital, Mueang District, Mahasarakham Province, Thailand 44000
Satchachon Changthom Department of Surgery, MahasarakhamHospital, Mueang District, Mahasarakham Province, Thailand 44000
Thanissara Namboonruang The Nursing Research and Development Department, Mahasarakham Hospital, Mueang District, Mahasarakham Province, Thailand 44000

DOI:

https://doi.org/10.64960/srimedj.v41i5.271438

Keywords:

laparoscopic cholecystectomy, three-dimensional laparoscopy, two-dimensional laparoscopy, randomized controlled trial

Abstract

Background and objective: Laparoscopic cholecystectomy is the standard treatment for symptomatic gallstone disease. However, conventional two-dimensional (2D) laparoscopic systems have limitations in depth perception, which may affect surgical precision. Three-dimensional (3D) laparoscopic systems have been developed to improve visualization and spatial perception during surgery. This study aimed to compare the operative efficiency and safety of three-dimensional and conventional two-dimensional laparoscopic cholecystectomy.

Methods: A prospective randomized controlled trial was conducted in patients undergoing elective laparoscopic cholecystectomy at Mahasarakham Hospital between October 2068 - Feburay 2026. Patients were randomized into either the 3D or 2D laparoscopic group. Operative time, intraoperative blood loss, postoperative pain scores, surgeon difficulty score, image quality score, and postoperative complications were evaluated.

Results: Seventy patients were equally randomized into the 3D and 2D groups. Baseline characteristics, including age and body mass index (BMI), were comparable between groups. The mean operative time tended to be slightly shorter in the 3D group (41.83 vs. 43.94 minutes, p = 0.20), and intraoperative blood loss was lower (9.69 vs. 11.03 mL, p = 0.27), although these differences were not statistically significant. The image quality score was significantly higher in the 3D group (4.37 ± 0.49 vs. 4.09 ± 0.37, p = 0.008). Postoperative pain scores were significantly lower in the 3D group on postoperative day 1 (p = 0.017) and postoperative day 2 (p = 0.004). No major complications, conversion to open surgery, or readmissions were observed in either group.

Conclusion: Three-dimensional laparoscopic cholecystectomy may improve visualization and reduce postoperative pain without increasing operative risk. Further multicenter studies with larger sample sizes are required to confirm these findings.

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