- MEDICINE ATHENS MED4WOMAN ATHENS
- MEDICINE VOLOS MED4WOMAN VOLOS
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Obstetrician Gynaecologist
Doctor of Medicine, University of Athens Medical School
Panagiotis Polyzos, Gynaecologist Obstetrician, is active at the Institute of Life - IVF Unit of Iaso Maternity Hospital.
Laparoscopy has revolutionized surgery compared to open procedures, particularly in terms of reducing complications. Laparoscopy can be further enhanced through innovative technology, one such advancement being three-dimensional (3D) laparoscopy. Traditional laparoscopy places specific demands on the surgeon — they must navigate and operate within a three-dimensional space while viewing a two-dimensional image, resulting in loss of depth perception. Therefore, visual perception becomes the main challenge for successful laparoscopic surgery. A solution to this problem lies in 3D imaging systems. These systems were first developed as early as the 1990s; however, they were limited in image resolution and viewing conditions and were not widely accessible to most hospitals. As a result, 3D systems could not initially be implemented in the operating room. Since then, continuous innovation has driven the progress of laparoscopy: modern 3D imaging systems now provide outstanding image quality at more affordable prices. Studies have shown that the latest generation of 3D systems significantly outperform 2D solutions in terms of surgical efficiency and performance.
The result: Surgeons appreciate 3D laparoscopy and would prefer a 3D system. 3D laparoscopy: beginners learn faster, experienced surgeons perform better. 3D systems measurably improve spatial orientation as well as hand-eye coordination, and are perceived as less fatiguing. This is particularly beneficial for beginners: thanks to enhanced depth perception and better spatial awareness, they are able to learn new surgical techniques more quickly than with conventional 2D laparoscopy.
With 3D technology, a beginner can operate just as quickly as an experienced surgeon using 2D. However, even skilled laparoscopic surgeons benefit from 3D technology — performing tasks faster, with fewer errors, and with fewer complications. Therefore, three-dimensional laparoscopy offers measurable advantages over conventional 2D systems: improved depth perception, faster surgical performance, and higher patient satisfaction.
3D vs 2D Laparoscopy — The verdict is clear. When new medical or technological innovations enter routine clinical practice, there is often no immediate consensus regarding their benefits. However, the comparison between three-dimensional and two-dimensional laparoscopy has delivered a clear verdict in favor of 3D technology. The only remaining questions relate to how quickly surgeons can become familiar with the new systems and the speed of image processing. The advantages of 3D laparoscopy are particularly compelling in terms of improved depth perception and the resulting reduction in surgical risk. The 3D procedure is also highly effective from a hospital management perspective. Laparoscopy is used to visualize organs and anatomical structures in the abdominal cavity. It is performed for both diagnostic and — most importantly — surgical interventions. This minimally invasive approach leads to reduced trauma during surgery, decreased postoperative pain, a lower risk of infection, and fewer extensive tissue adhesions. The comparison between 3D and 2D laparoscopic procedures has been a significant research focus for many years, initially investigated in animal studies. Three-dimensional imaging systems have existed for almost two decades, but recent literature describes a renaissance in 3D imaging technologies. More and more reputable manufacturers are bringing new 3D systems to the market.
Crucial improvements in these systems have driven demand — and positively influenced pricing. The most notable of these improvements is the significantly enhanced imaging quality, enabled by increased processing power — a development also seen in digital microscopy. Achieving this level of image quality twenty years ago would have required much larger and far more expensive equipment. 3D laparoscopic systems are now available at reasonable costs. A look inside modern hospitals shows that 3D laparoscopy continues to gain popularity — largely because of how easy it is to learn, even for less experienced surgeons. Expanded functionality and enhanced safety. The broader range of procedures now performed laparoscopically is due primarily to the improved imaging capabilities of 3D systems. A recent clinical study by Baum et al. investigated the impact of three-dimensional laparoscopy on the efficiency and safety of gynecologic surgeries. Significant advantages were found in suturing and in the dissection of anatomical structures when 3D visualization was used.
Compared with 2D laparoscopy, surgeons found the representation of spatial depth to be particularly advantageous — a key factor contributing to improved safety levels in surgical procedures. Visualization of retroperitoneal neural structures was significantly enhanced. Improvements in the visualization of the uterus, ureter, and blood vessels were not as pronounced. Nevertheless, Baum et al. reached a strongly positive conclusion: working with 3D laparoscopy provides surgeons with substantial advantages over 2D systems. The spatial representation seen in the images closely resembles real anatomical conditions.
Similar conclusions are reported in several other studies. In a comparative study, 53 patients underwent surgery for various indications (including ovarian cysts, hernia, and cholelithiasis). One group was treated with three-dimensional laparoscopy and the other with 2D technology. The greatest disadvantage of 2D laparoscopy is the lack of depth perception. This increases the cognitive load on surgeons during procedures and may negatively affect surgical safety. The 3D group demonstrated a clear advantage, with significantly shorter operative times. Surgeons reported that superior image quality — particularly the enhanced perception of depth — was a decisive factor in achieving faster procedures. Other advantages of 3D technology include improved hand-eye coordination and increased surgical precision. These improvements allow surgeons to work more accurately and with fewer errors, achieving safe dissection even of extremely delicate tissue structures. Less experienced surgeons benefit the most: they are able to learn operative skills and anatomical relationships faster and more effectively.
The financial benefits for hospitals are obvious: in certain cases, significantly shorter operating times reduce the amount of anesthetic agents required. In addition, the existing laparoscopic instruments — for example, all those with a straight design — can also be used with 3D technology.
Patients can be discharged to postoperative care in better overall health conditions. The potential disadvantages are more related to surgeons’ subjective adaptation to viewing through 3D glasses, as well as to the need for even faster data processing. Overall, the advantages of three-dimensional laparoscopy are undeniable. In fact, this was already predictable even before the full establishment of the technology in routine clinical practice. This is reflected on page 247 of the proceedings of the 51st Congress of the German Society of Gynecology and Obstetrics: “If one sets aside economic considerations, there is no way to understand why all surgeons do not immediately switch to three-dimensional imaging, since these are the images we are all accustomed to from everyday life.”
