Two-dimensional vs. three-dimensional laparoscopic transabdominal preperitoneal (TAPP) hernia repair: a systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: p = 0.0008

• Effect Size: Mean difference -18.48 minutes favouring 3D

• Primary Outcome: Total operative time significantly shorter with 3D laparoscopy

• Nnt Or Sensitivity: Effect consistent across RCTs (MD -11.70 min) and observational studies (MD -26.85 min)

• Confidence Interval: 95% CI -29.27 to -7.69 minutes

Clinical Application

Limited by equipment availability, cost considerations, and surgeon training requirements for 3D systems Relevant to Australian practice where TAPP is standard care; cost-effectiveness analysis needed for PBS consideration of 3D equipment; aligns with RACS guidelines for minimally invasive hernia repair Adults undergoing elective TAPP inguinal hernia repair in centres with 3D laparoscopic capability

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.

References

1. 1.Elstohy, A., Shelbaia, F. H., Elsobky, M., Ghriwati, M. N., Alghzawi, H. M., Sarah, A., Hajajra, A. T., & Deibes, T. (2026). Two-dimensional vs. three-dimensional laparoscopic transabdominal preperitoneal (TAPP) hernia repair: a systematic review and meta-analysis. Hernia, Article 1249683. https://doi.org/10.3389/fonc.2023.1249683