- ATHENS OFFICE MED4WOMAN ATHENS
- VOLOS OFFICE MED4WOMAN VOLOS
Obstetrician-Gynecologist
PhD, University of Athens Medical School
Obstetrician-gynecologist Panagiotis Polyzos practices at the Institute of Life, the IVF Unit of IASO Maternity Hospital.
Laparoscopy has revolutionized surgery compared with open procedures, especially in reducing complications. Laparoscopy can be improved even further through innovative technology. One such approach is 3D laparoscopy. Conventional laparoscopy places particular demands on the surgeon: they must navigate and operate in three-dimensional space using a two-dimensional image, losing depth perception. Accordingly, visual perception is the main challenge for successful laparoscopic surgery. One solution to this problem is 3D imaging. Such systems were developed as early as the 1990s, but they were still limited in image resolution and viewing conditions and were out of reach for most hospitals. As a result, 3D systems could not be used in the operating room at first. Since then, however, innovation has driven the progress of laparoscopy: the latest 3D imaging systems deliver excellent image quality at more affordable prices. Studies show that new-generation 3D systems in particular outperform 2D solutions.
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.
In training studies, less experienced surgeons completed laparoscopic exercises in 3D in times close to those of more experienced colleagues using 2D. Experienced laparoscopic surgeons also benefit from 3D technology and perform surgical movements with greater precision and fewer errors. As a result, 3D laparoscopy offers measurable advantages over standard 2D systems: better depth perception, faster operation 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.”
For the patient, 3D laparoscopy is exactly like conventional laparoscopy. The incisions are the same in number and size, anesthesia is general and the preparation is no different. The difference is on the operating room screen: the team wears special glasses and sees the inside of the abdomen with depth, as they would with the naked eye.
This translates into more confident and precise maneuvers, especially in suturing and in separating delicate tissues. In complex procedures, it can shorten operating time and therefore time under anesthesia. What each patient gains depends mainly on the type of procedure and the surgeon's experience. Technology enhances skill, it does not replace it.
Both techniques offer a three-dimensional image. The difference lies in the instruments and in how the surgeon handles them.
The choice depends on the specific procedure, availability and the team's experience. For many benign gynecologic conditions, 3D laparoscopy offers excellent precision with less complexity.
3D imaging is not a magic solution. Some surgeons experience eye strain or headaches from the glasses during long procedures. The greatest benefits in studies relate to speed and precision in demanding tasks, while in simple procedures the difference for the patient is small. That is why 3D is used where it adds real value, and not as a marketing feature.
The principle is the same as human vision. Our two eyes see the same object from slightly different angles, and the brain combines the two images into one with depth. The 3D laparoscopy camera has two tiny sensors at its tip, set a short distance apart, that capture two images at the same time.
The images are displayed on a special high-definition monitor. The polarized glasses worn by the surgical team let each eye see only its “own” image. The result is a natural sense of depth: the surgeon can judge how far the instrument is from the tissue without having to “feel for it” with trial movements, as often happens with a flat image. The camera is inserted through the same incision in the navel used in conventional laparoscopy, so nothing changes for you.
The surgeon sees the surgical field with a sense of depth, as in open surgery, which makes delicate maneuvers and suturing easier.
The incisions and recovery are the same as with conventional laparoscopy. The benefit lies in precision and, often, shorter operating time.
Mainly the more demanding ones, such as fibroid removal, endometriosis surgery and hysterectomy.
No. Preparation is the same as for any laparoscopy: preoperative testing, fasting before anesthesia and letting the team know about the medications you take.
Studies show that the 3D image improves precision and reduces errors in surgical maneuvers, especially in suturing. Serious complications are rare with both techniques, and safety depends primarily on the surgeon's experience.
You can discuss it with your surgeon. They will explain whether 3D offers a real advantage for your procedure and whether the system is available at the clinic where you will have surgery.
Recovery depends mainly on the type of procedure, not on the camera. The incisions are the same as in conventional laparoscopy, so the time it takes to return to your activities is similar. In complex procedures, the shorter operating time may help you recover more smoothly from anesthesia.
No additional risks. The technology only affects the image the surgical team sees. Possible complications are those of any laparoscopy and depend on the procedure.
