Advantages of the 3- vs. the 2-Dimensional Laparoscopic Technology in Bariatric Surgery

Background Bariatric surgery procedures as the laparoscopic Roux-en-Y-Gastric Bypass (RYGB) are highly standardized procedures. The difficulty in two-dimensional (2D) laparoscopic surgery is the loss of the depth perception which complicates surgical techniques as suturing and knotting. The development of three-dimensional (3D) laparoscopy has been shown to reduce operative times and surgeons’ performances errors. Aims To compare operative times, post-operative complications and the lengths of hospital stay of patients having undergone laparoscopic RYGB before and after the introduction of the 3D-technology. Methods We conducted a retrospective cohort study including patients having undergone RYGB (without cholecystectomy) at our institution by the same surgical team before and after the introduction of the 3D-laparoscopic technology (Karl Storz, Tuttlingen, Germany). The primary outcome was the operative time, the secondary outcomes the post-operative complications and lengths of hospital stay. Results 100 consecutive patients, operated on 2019-2021 were included; 50 were operated utilizing the 2D- and 50 the 3D laparoscopic technology. There were no statistically significant differences in age, gender, body mass index or comorbidities, however, patients in the 3D-group had significantly more previous interventions. Operative time and hospital length of stay were significantly reduced in the 3D-group (83 (± 20.8) vs. 91 (± 13.5) minutes; p < 0.05 and 2.1 (± 0.4) vs. 2.7 (± 1.1) nights; p < 0.05). There were no statistically significant differences found between groups concerning post-operative complications and re-interventions. Conclusion 3D technology may help reducing the operative time and length of hospital stay in laparoscopic RYGB surgery with similar post-operative complications. We cannot completely exclude reduced operative times by the still growing experience of the surgical team.