Impact of 3D high-definition laparoscopy on total laparoscopic hysterectomy: a body mass index-stratified retrospective analysis

BACKGROUND:
Three-dimensional (3D) high-definition (HD) laparoscopy is a promising tool in minimally invasive gynecologic surgery, offering enhanced depth perception and visualization. However, its role in total laparoscopic hysterectomy (TLH), particularly in patients with varying body mass index (BMI), remains underexplored.


OBJECTIVE:
To evaluate the impact of 3D HD laparoscopy on surgical efficiency and patient outcomes in TLH, with a focus on BMI-related differences.


DESIGN AND SETTINGS:
A single-center retrospective study


PATIENTS AND METHODS:

Sixty patients who underwent TLH were included: n=30 used 3D HD laparoscopy (Aesculap 3D EinsteinVision) and n=30 matched controls used 2D laparoscopy. Matching criteria included uterine weight and prior surgical history. Patients were stratified according to BMI (≤24.9, 25–29.9, ≥30.0 kg/m
2
).



MAIN OUTCOME MEASURES:
Operative time, vault suturing time, blood loss, trocar site incisions, haemoglobin drop, and complication rates.


SAMPLE SIZE:
60 patients (30 in each group)


RESULTS:

The 3D HD laparoscopy group demonstrated significant improvements across multiple outcomes. Trocar site incisions were significantly reduced in all BMI categories (
P
<.001). Vault suturing time was shorter in the 3D HD laparoscopy group (
P
=.002), and total operative time was reduced in overweight patients (
P
=.015). Obese patients in the 3D group had lower haemoglobin drop (
P
=.01) and reduced blood loss compared to 2D laparoscopy group (
P
=.017).



CONCLUSION:
3D HD laparoscopy enhances surgical efficiency in TLH, especially in patients with higher BMI, by minimizing trocar site incisions, reducing vault suturing times, and improving hemostasis—highlighting its value in overcoming challenges of minimally invasive gynecologic surgery.


LIMITATIONS:
The study's retrospective design and modest sample size limit generalizability.