Introduction Laparoscopic cholecystectomy is the standard treatment for symptomatic cholelithiasis. Although 3D laparoscopy may improve depth perception, its effects on efficiency, ergonomics, and complication rates in comparison to 2D systems remain unclear. Methods In this prospective, single-blinded, randomized comparative study, 100 patients underwent elective laparoscopic cholecystectomy at the Department of General and Minimal Access Surgery in a tertiary care teaching hospital in North India. Patients were randomized equally to 3D (Group A) or 2D laparoscopy (Group B). Exclusion criteria included prior major abdominal surgery, coagulopathy, or pregnancy. Total performance time, surgeon’s subjective depth perception (scale 1-5), strain scores (eye, wrist/hand, neck/back, dizziness/headache), intraoperative complications, conversion rates, and hospital stay were documented through surgical records and postoperative questionnaires. Results The total performance time was significantly shorter in the 3D group (46 min) compared to the 2D group (50 min; p=0.0074). The median depth perception score was higher in the 3D group (5.0 vs. 2.0; p<0.001). Wrist/hand strain was lower in the 3D group (median 2.0 vs. 3.0; p=0.0117), while eye strain (4.0 vs. 3.0; p=0.0021) and dizziness/headache (4.0 vs. 2.0; p<0.001) were greater. There were no significant differences in neck/back strain (p=0.81), rates of gallbladder rupture (10% vs. 12%; p=0.76), liver bed bleeding (10% vs. 14%; p=0.76), biliary injury (none), conversion rates (2% in both), or hospital stay (2.06 days each; p=0.78). Conclusions 3D laparoscopy enhances operative efficiency and depth perception while reducing wrist/hand strain. However, increased eye strain and dizziness warrant further technological optimization to improve the overall ergonomic profile for surgeons.
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