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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2021; 13(6): 597-619
Published online Jun 27, 2021. doi: 10.4240/wjgs.v13.i6.597
2D vs 3D laparoscopic right colectomy: A propensity score-matching comparison of personal experience with systematic review and meta-analysis
Gianluca Costa, Pietro Fransvea, Luca Lepre, Fabio Rondelli, Alessandro Costa, Michela Campanelli, Giorgio Lisi, Maria Rosaria Mastrangeli, Giovanni Guglielmo Laracca, Giovanni Maria Garbarino, Graziano Ceccarelli
Gianluca Costa, Surgery Center, Campus Bio-Medico, Rome 00128, Italy
Pietro Fransvea, Department of Emergency and Trauma Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
Luca Lepre, General Surgery Unit, Santo Spirito in Sassia Hospital, Rome 00193, Italy
Fabio Rondelli, Department of Surgical Science, University of Perugia, Santa Maria Teaching Hospital, Terni 05100, Italy
Alessandro Costa, Catholic University “Our Lady of Good Council” School of Medicine, Tirane 1023, Albania
Michela Campanelli, Department of Emergency Surgery, Tor Vergata University Hospital, Rome 00133, Italy
Giorgio Lisi, Maria Rosaria Mastrangeli, Department of General Surgery, Sant'Eugenio Hospital, Rome 00144, Italy
Giovanni Guglielmo Laracca, Giovanni Maria Garbarino, Department of Medical Surgical Science and Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome 00189, Italy
Graziano Ceccarelli, General Surgery Unit, San Giovanni Battista Hospital, Foligno 06034, Italy
Author contributions: Costa G, Ceccarelli G and Rondelli F contributed to the study conception and design; Fransvea P, Lepre L, Rondelli F, and Garbarino GM contributed to the literature search and data extraction; Costa G, Costa A, Campanelli M, and Laracca GG contributed to the acquisition, management, analysis and interpretation of data; Costa G, Fransvea P, and Garbarino GM drafted the manuscript; Costa G, Ceccarelli G, Lisi G, and Laracca GG critically revised the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Giorgio Lisi, MD, Medical Assistant, Department of General Surgery, Sant'Eugenio Hospital, Piazzale dell'Umanesimo 10, Rome 00144, Italy. giolimas06@yahoo.it
Received: March 15, 2021
Peer-review started: March 15, 2021
First decision: May 4, 2021
Revised: May 4, 2021
Accepted: May 19, 2021
Article in press: May 19, 2021
Published online: June 27, 2021
BACKGROUND
The benefits of laparoscopic approach for right colectomy have been well established. However, the technical difficulty to construct the intra-corporeal anastomosis is still cumbersome.
AIM
To analyze the results of 3D and 2D laparoscopic right colectomy and to compare it to the published series through a systematic review and meta-analysis.
METHODS
A retrospective study with propensity score matching analysis of patients undergoing laparoscopic right colectomy at Umbria2 Hospitals from January 2014 to March 2020 was performed. A systematic review was accomplished comparing 2D and 3D right colectomy.
RESULTS
In the personal series 47 patients of the 2D group were matched to 47 patients of the 3D group. The 3D group showed a favorable trend in terms of mean operative time (170.7 ± 32.9 min vs 183.8 ± 35.4 min; P = 0.053) and a significant lower anastomotic time (16.9 ± 2.3 min vs 19.6 ± 2.9 min, P < 0.001). The complete mesocolic excision (CME) subgroups analysis showed a shorter anastomotic time (16.5 ± 1.8 min vs 19.9 ± 3.0 min; P < 0.001) and operative time (175.0 ± 38.5 min vs 193.7 ± 37.1 min; P = 0.063) in the 3D group. Six studies and our series were included in the meta-analysis with 551 patients (2D group: 291; 3D group: 260).The pooled analysis demonstrated a significant difference in favour of the 3D group regarding the operative time (P < 0.001) and the anastomotic time (P < 0.001) while no differences were identified between groups in terms of blood loss (P = 0.827), LNH yield (P = 0.243), time to first flatus (P = 0.333), postoperative complications (P = 0.718) and length of stay (P = 0.835).
CONCLUSION
The meta-analysis results showed that 3D laparoscopic right colectomy shortens operative and anastomotic time without affecting the standard lymphadenectomy. In our series, the advantage of the 3D system becomes evident when CME and/or more complex associated procedure are requested significantly reducing both the total operative and the anastomotic time.
Core Tip: The technological improvements introducing the three-dimensional vision in laparoscopic systems provided some of the advantages of robotic platform; thus, 3D laparoscopic surgery has emerged as a competitive alternative to the robotic one. Recently, we compared robotic surgery and 3D laparoscopy for right colectomy with complete mesocolic excision and intra-corporeal anastomosis. Now, we undertook the present study with the aim to appraise our whole experience in the use of 3D laparoscopic system in right colectomy. In addition, we performed a meta-analysis in order to compare our results to the literature ones in the attempt to increase the statistical power and level of evidence.
