Clinical Use of Third-Generation 3D Imaging Systems in Endoscopic Surgery—a Systematic Review

Translational research allowed us to hypothesize that endoscopic surgery performed with new generation 3D systems could improve surgeons’ performance, reducing the learning curve, and the perceived workload. However, there is currently a lack of evidence in randomized clinical trials considering advantages for the surgeon and the patient of using the new 3D systems. This systematic review of literature aims to understand what are the differences when performing an endoscopic surgery with new 3D or 2D systems when it comes to intra-operative, post-operative and surgeons perspective outcomes, and at the same time, understand what were the difficulties encountered when performing research about as different imaging systems for surgeons. A systematic review of literature was conducted through an online search in databases MEDLINE ©/PubMed © to identify articles published in English, from 1st January 2014 to 31st May 2019, that compared clinical results of 2D and 3D third-generation video-assisted surgery. A total of 30 articles were included in the qualitative analyses. Of the 30 articles analyzed, 13 were articles in which patients were randomly selected, of which 7 were considered to be at “Low” risk of bias. From the 7 articles, 2 demonstrated an association between lower blood loss and 3D systems. In this selection of low risk randomized articles, no differences were observed in any of the studies when it comes to conversion to open surgery, intra-operative complications, morbidity, length of stay, and oncological outcomes. In conclusion, this systematic review presents the current knowledge on clinical use of 3D systems for endoscopic surgery. Significant scientific evidence puts 3D technology with advantages in surgeon performance, learning curve, and fatigue.