This systematic review and meta-analysis compared three-dimensional (3D) laparoscopy against two-dimensional (2D) laparoscopy for repairing inguinal hernias in adults. The analysis included data from 521 patients. Researchers looked at total operative time, visualization quality, sharpness of images, and postoperative complications. The study found that 3D laparoscopy led to a shorter total operative time. It also showed better visualization contrast. There was no difference in image sharpness or the rate of postoperative complications between the two methods. No adverse events or discontinuations were reported in the safety data. However, the evidence has very low certainty. This uncertainty comes from variability in surgeon experience and substantial differences between the studies included in the analysis. Readers should interpret these results with caution. The high variability in surgeon experience suggests that outcomes may depend heavily on the individual surgeon's skill level. While the data points to potential benefits for 3D technology, the limitations mean these findings should not be seen as definitive proof of superiority in all settings. Further research with more consistent methods is needed to confirm these results.
Systematic review and meta-analysis shows 3D laparoscopy reduces operative time in adult inguinal hernia repairMeta-analysis shows 3D laparoscopy shortens time for inguinal hernia repair
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Key Takeaway
Note very low certainty evidence for 3D laparoscopy benefits in inguinal hernia repair.
This systematic review and meta-analysis compares three-dimensional versus two-dimensional laparoscopy for inguinal hernia repair in adults. The analysis included n=521 patients, though the setting was not reported. The primary outcome was total operative time, while secondary outcomes included visualization and postoperative complications. Follow-up duration was not reported.
Results indicated that 3D laparoscopy favored shorter total operative time with a mean difference of -18.48 min and a 95% CI of -29.27, -7.69; p = 0.0008. For visualization contrast, 3D was favored with a mean difference of 2.11 and a 95% CI of 0.56, 3.67; p = 0.008. Visualization sharpness showed no statistically significant difference with a mean difference of 1.49 and a 95% CI of -0.25 to 3.24; p = 0.09. Postoperative complications showed no difference with a mean difference of 1.11 and a 95% CI of 0.75, 1.65; p = 0.59.
Safety data such as adverse events, serious adverse events, discontinuations, and tolerability were not reported. The authors highlight substantial heterogeneity with an I-squared of 94% and variability in surgeon experience. The certainty of evidence is very low. Interpretation of results should be done with caution due to these limitations.
What this means for you:
Meta-analysis suggests 3D laparoscopy may shorten surgery time for inguinal hernia repair, but evidence certainty is very low. More on Inguinal Hernia
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View Original Abstract ↓
BACKGROUND: Two-dimensional (2D) laparoscopy provides limited depth perception, which may limit performance during technically demanding operations. Three-dimensional (3D) systems offer stereoscopic vision, improving visualization. We compared 3D versus 2D systems in adults for operative time, visualization, and postoperative complications.
METHODS: PubMed, Scopus, Web of Science, and Cochrane were searched through December 2025. We included randomized controlled trials and observational studies of patients undergoing TAPP repair, comparing 3D with 2D laparoscopy. Total operative time was the primary outcome; visualization and postoperative complications were secondary outcomes. Risk of bias was assessed using RoB 2 and the Newcastle-Ottawa Scale, and certainty of evidence using GRADE.
RESULTS: Six studies met the inclusion criteria; five were included in the primary meta-analysis (n = 521 patients). Total operative time favored 3D (MD-18.48 min; 95% CI-29.27,-7.69; p = 0.0008), with substantial heterogeneity (I²=94%). Subgroup analysis also favored 3D in RCTs (MD-11.70; 95% CI-17.74,-5.66) and observational studies (MD-26.85; 95% CI-30.55,-23.15). Contrast favored 3D (MD 2.11; 95% CI 0.56, 3.67; p = 0.008), while sharpness was not statistically different (MD 1.49; 95% CI-0.25 to 3.24; p = 0.09). No difference in postoperative complications (MD 1.11; 95% CI 0.75, 1.65; p = 0.59).
CONCLUSION: 3D laparoscopy has been proposed to improve visualization and shorten operative time; however this should be interpreted with caution due to very low certainty of evidence and variability in surgeon experience.
REGISTRATION/FUNDING: PROSPERO CRD420251272842.
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