Two dimensional versus three dimensional video-assisted mediastinal lymphadenectomy: a meta-analysis

Duilio Divisi, Mirko Barone, Gino Zaccagna, Roberto Crisci


Background: To investigate current role of three-dimensional video-assisted thoracoscopic surgery (VATS) and its differences from conventional flat video-assisted procedures for lymph node dissections in both pulmonary and esophageal cancers.
Methods: A PubMed Embase, Google Scholar, OpenDOAR research was carried out according to a prepended Boolean function in order to speculate some difference in mean harvested lymph nodes, blood loss and postoperative chylothorax according to the techniques.
Results: Electing six articles, for a total of 1,262 patients (609 3D-VATS and 653 2D-VATS patients), significant differences favouring a 3D approach were found in mean node count [mean difference: 1.56; standard error (SE): 0.23; 95% confidence interval (95% CI): 1.11–2.01, difference freedom (DF) =1,260; t=6.85; P<0.001] and in a reduced intraoperative blood loss (mean difference: 11.07; SE: 1.22; 95% CI: 8.68–13.45, DF=1,260; t=9.10; P<0.001). Otherwise, a stroboscopic approach did not influence the pooled incidence of postoperative chylothorax (percentage difference: 0.07; χ2=0.009; 95% CI: −1.61–1.69, DF=1; P=0.926).
Conclusions: The management of the hilar and mediastinal lymphatic areas seems to be ameliorated by the adoption of three-dimensional video-assisted strategies potentially significantly influencing patients’ outcome.