Two-dimensional vs. three-dimensional vision during the laparoscopic radical prostatectomy: A matched comparison of operative and long-term functional outcomes

2D vs. 3D laparoscopic radical prostatectomy

Abstract

Background/Aim: The three-dimensional (3D) display system can solve essential problems in conventional laparoscopic radical prostatectomy (LRP), like depth perception and spatial orientation. Several studies reported initial comparisons of LRP with 2D and 3D vision systems in terms of operative outcomes, with 3D systems coming out on top. However, there are few published comparison studies on the long-term outcomes of LRP with 2D and 3D vision systems. In this regard, we aimed to compare operative and long-term functional results of 3D-High definition (HD) LRP with conventional two-dimensional (2D)-HD display systems.

Methods: A total of 115 cases that underwent LRP between October 2010 and December 2016 were prospectively evaluated, and a prospective cohort study was conducted. Inclusion criteria at baseline were as follows: age at surgery <75 yr, prostate-specific antigen (PSA) concentration <20 ng/ml, clinical tumor stage <T4, no diagnosis of metastatic disease, and informed consent to participate in the study. Patients who underwent salvage treatments after LRP and patients with incomplete follow-up were excluded. The patients were divided into groups, Group 1 (n=72) and Group 2 (n=43), according to the display systems used, 2D-HD vs. 3D-HD during LRP. Demographic data, operative and postoperative, and long-term follow-up outcomes were recorded. Additionally, urinary continence rate determined with a patient questionnaire and erectile functions determined with the International Index of Erectile Function (IIEF) questionnaire were recorded. All obtained parameters were compared between the groups using the independent t-test and the chi-square test. Differences were considered significant at two-sided P <0.05 and 95% confidence interval.

Results: All patients completed a 24-month follow-up procedure. The groups were similar in age, serum PSA level, prostate volume, preoperative Gleason score, and cancer-positive core number. There were significantly better results in group 2 than in group 1 for operative parameters, catheterization time, and hospital stay (P<0.001, for all parameters). At long-term follow-up, the urinary continence rate was significantly higher in group 2 than in group 1 (P=0.023). Similarly, significantly higher IIEF scores were determined in the group 2 (P<0.001).

Conclusion: Our results suggest that using a 3D-HD display system during LRP provides much better long-term functional and operative outcomes and may provide a cheap and equal alternative to the RARP procedure.