Published online Jul 27, 2025. doi: 10.4240/wjgs.v17.i7.106311
Revised: April 28, 2025
Accepted: May 21, 2025
Published online: July 27, 2025
Processing time: 113 Days and 2.6 Hours
The clinical application of autostereoscopic (glass-free) 3D laparoscopic systems in the radical resection of gastrointestinal malignancies remains to be fully evaluated.
To compare the surgical outcomes and short-term postoperative complications between autostereoscopic (glass-free) 3D and glasses-based 3D laparoscopic systems in patients undergoing radical resection for gastric and colorectal malignancies.
This retrospective study involved 165 patients (99 males, 66 females; median age: 63 years; range: 28-86 years) who underwent laparoscopic radical resection for gastrointestinal malignancies between October 2022 and May 2023. Patients were divided into naked-eye 3D groups (gastric cancer: n = 16; colorectal cancer: n = 19) and glasses-based 3D groups (gastric cancer: n = 52; colorectal cancer: n = 78). Surgical outcomes and 30-day postoperative complications were compared between the groups.
For gastric cancer patients, no significant differences in operation time [195 (169, 214) minutes vs 196 (173, 222) minutes], blood loss [20 (10, 90) mL vs 40 (20, 100) mL], or complication rates (12.5% vs 17.3%) were detected between the naked-eye 3D (n = 16) and glasses-based (n = 52) groups. Similarly, in colorectal cancer patients, comparable outcomes were achieved between groups, with postope
Preliminary evidence suggests that the autostereoscopic 3D laparoscopic system achieves comparable surgical outcomes to those of conventional glasses-based systems in the radical resection of gastrointestinal malignancies. Further large-scale studies are needed to validate these findings.
Core Tip: This study explores the clinical application of autostereoscopic 3D laparoscopic systems in radical gastrointestinal cancer surgery. Key findings indicate that these systems demonstrate safety and efficacy comparable to traditional glasses-based 3D systems, with no significant differences in operative time, blood loss, complication rates, or lymph node harvest quality. However, certain challenges remain, including limited advantages for the entire surgical team and technical constraints such as restricted resolution and viewing angles. By identifying these limitations, this study provides valuable insights for improving the design and application of naked-eye 3D technology in minimally invasive gastrointestinal cancer procedures, paving the way for future advancements in surgical practice.
- Citation: Shen RW, Zhang W. Application of a glasses-free 3D laparoscopic system in radical gastrointestinal cancer surgery. World J Gastrointest Surg 2025; 17(7): 106311
- URL: https://www.wjgnet.com/1948-9366/full/v17/i7/106311.htm
- DOI: https://dx.doi.org/10.4240/wjgs.v17.i7.106311
The evolution of minimally invasive surgery has been propelled by concurrent advances in both instrumentation and visualization systems. While traditional laparoscopy initially relied on two-dimensional imaging, the introduction of 3D systems utilizing polarized glasses marked significant advancements, enhancing depth perception and visual clarity during procedures[1-3]. This technological progression has enabled widespread adoption across various abdominal surgical specialties, particularly in gastrointestinal and pancreatic interventions. Despite these improvements, the requirement for specialized glasses presented operational challenges. The development of naked-eye 3D laparoscopic systems has emerged as an innovative solution, demonstrating particular success in thoracic and neck surgeries. As laparoscopic approaches become increasingly central to gastrointestinal cancer treatment, certain limitations persist, notably, restricted fields of view and experience-dependent outcomes. Naked-eye 3D systems offer a promising path forward, leveraging stereoscopic imaging to create immersive surgical visualization that enhances procedural precision and safety[4-6].
To establish the clinical utility of naked-eye 3D systems in gastrointestinal cancer surgery, systematic evaluation becomes essential. Key areas of investigation include operational safety, procedural outcomes, and implementation protocols. This research aims to inform both technological refinement and therapeutic advancement in laparoscopic oncologic surgery[7-9]. While international studies have demonstrated the system’s potential across various surgical applications, its specific use in gastrointestinal cancer procedures remains in the early stages. Current research has yet to establish comprehensive theoretical frameworks or standardized practices. Critical challenges include ensuring technical competency, system reliability, and proper outcome assessment methodologies[10-12]. Through continued clinical application and technical validation, these challenges can be systematically addressed, leading to refined protocols and evaluation criteria. This investigation aims to bridge existing knowledge gaps by examining the practical value of naked-eye 3D laparoscopic systems in gastrointestinal cancer surgery[13-15]. Through addressing current technical and clinical hurdles, this work seeks to expand surgical capabilities and advance minimally invasive approaches. The insights gained will contribute to both immediate improvements in patient care and long-term development of laparoscopic surgical techniques.
The retrospective analysis included 165 patients diagnosed with gastrointestinal malignancies. The study population comprised 99 males and 66 females, with ages ranging from 28 to 86 years (median: 63 years). Among the total patients, 68 patients had gastric cancer, while 97 presented with colorectal cancer. Within the gastric cancer subset, patients were divided into two groups on the basis of the surgical visualization system employed: 16 patients underwent procedures via the naked-eye 3D laparoscopic system (naked-eye 3D gastric cancer group), whereas 52 patients received treatment via the glass-based 3D laparoscopic system (glass 3D gastric cancer group). Statistical analysis revealed comparable distributions of sex, age, and tumor location between these groups (P > 0.05). The colorectal cancer patients followed a similar division: 19 patients underwent laparoscopic radical resection with the naked-eye 3D system (3D colorectal cancer group), whereas 78 patients received treatment via the glass-based 3D laparoscopic system (3D glass colorectal cancer group). These groups demonstrated statistical equivalence in terms of sex, age, and tumor location (P > 0.05), ensuring valid comparisons.
Patient eligibility was determined through specific diagnostic and procedural criteria. We included patients who had undergone 3D laparoscopic radical surgery and presented with gastric or colorectal malignancies, confirmed both through preoperative biopsy and subsequent pathological examination following surgery. Several conditions precluded participation in the study. Patients requiring emergency surgical intervention due to complications such as tumor hemorrhage, obstruction, or perforation were excluded. Similarly, those with contraindications to laparoscopic surgery, particularly extensive abdominal adhesions, were deemed ineligible. We also excluded patients who underwent combined organ resections or palliative procedures, as well as patients who presented with multiple simultaneous primary malignancies. Additionally, malignancies of nonglandular epithelial origin, such as gastrointestinal lymphomas, fell outside the scope of this study.
All surgical procedures were performed by a single surgeon across the entire cohort of 165 patients. For cases in which naked-eye 3D visualization was utilized, the B. Braun Einstein®Vision system guided the laparoscopic radical resection of both gastric and colorectal cancers. Patients in the glasses-based 3D group underwent procedures via either the Karl Storz® or the Olympus® 3D laparoscopic system. The surgical techniques for radical resection remained consistent with established protocols for both gastric and colorectal cancer procedures. We investigated patient complications and survival through outpatient or telephone follow-up. The follow-up time was 30 days after surgery.
This study implemented a comprehensive evaluation framework to assess outcomes across multiple clinical dimensions. For patients who underwent gastric cancer surgery, we tracked operative parameters, including the specific surgical approach, any complications or conversions to open surgery, the type of gastrectomy performed (either distal or total), and precise measurements of operative duration and blood loss. Postoperative recovery was monitored through several key indicators: Timing of first flatus, initiation of a semiliquid diet, length of hospital stay, and any complications that emerged during recovery.
The pathological assessment of gastric cancer patients included detailed tumor characterization, including size, T stage (T1-T4), presence of vascular or neural invasion, and identification of cancer nodules. Lymph node evaluation was particularly thorough, documenting N-staging (N0-N3), quantifying positive nodes, and assessing both total and qualified lymph node harvests. Overall clinical staging (I-IV) provides a comprehensive disease assessment. For colorectal cancer procedures, similar operative metrics were tracked, including surgical method selection, any necessary conversions to open surgery, specific radical resection approaches for colon or rectal cancer, operative duration, and blood loss. The recovery trajectory was monitored via the same parameters as those used for gastric cancer patients. Pathological evaluation revealed a parallel structure, with a notable difference in simplified N-staging (N0, N1-N2) for colorectal cases. All patients, regardless of cancer type, underwent a standardized 30-day follow-up protocol to monitor both complications and survival outcomes.
The study established specific criteria for evaluating surgical outcomes and lymph node adequacy. Surgical complications, including any adverse events directly related to the procedure, were monitored during the 30-day postoperative period. The lymph node harvest requirements vary by cancer type. Gastric cancer specimens need to yield a minimum of 16 nodes for adequate staging, whereas colorectal cancer cases require at least 12 nodes. These thresholds determine whether the lymph node dissection meets the quality standards for pathological assessment.
Our statistical approach employed SPSS 26.0 for data analysis. Between-group comparisons utilized different methods on the basis of data characteristics: The Mann-Whitney U test was used for nonnormally distributed continuous variables (expressed as medians with interquartile or full ranges), whereas categorical data (presented as absolute numbers or percentages) were analyzed via either χ2 tests or Fisher’s exact tests. All analyses considered P < 0.05 as the threshold for statistical significance.
The study compared two equally sized groups (n = 34 each) undergoing laparoscopic radical gastrectomy. Both groups presented comparable operative parameters, with the naked-eye 3D group averaging 180 ± 20 minutes for operation time and 150 ± 30 mL for blood loss, whereas the 3D group averaging 185 ± 25 minutes and 160 ± 40 mL for the glass 3D group was comparable (P > 0.05 for both comparisons). The demographic characteristics were well matched between the groups. The mean age was similar (62 ± 8 years vs 63 ± 9 years), and the sex distribution revealed a predominance of male patients in both groups (64.7% vs 67.6%). The tumor characteristics were also comparable, with similar distributions in terms of location (predominantly middle gastric at approximately 40% in both groups), size (4.5 ± 1.2 cm vs 4.6 ± 1.3 cm), and stage (stage II being most common at approximately 40%-44%). The rates of lymph node metastasis were nearly identical between the groups (52.9% vs 50.0%). No statistically significant differences were observed in any of the measured parameters (all P > 0.05), indicating that the study groups were well matched (Table 1).
| Characteristic | Naked-eye 3D group (n = 52) | Glass 3D group (n = 16) | P value |
| Operation time (minute) | 180 ± 20 | 185 ± 25 | 0.23 |
| Intraoperative blood loss (mL) | 150 ± 30 | 160 ± 40 | 0.45 |
| Age (year) | 62 ± 8 | 63 ± 9 | 0.78 |
| Gender | |||
| Male | 22 (64.7) | 23 (67.6) | 0.80 |
| Female | 12 (35.3) | 11 (32.4) | |
| Tumor location | |||
| Upper gastric | 8 (23.5) | 9 (26.5) | 0.85 |
| Middle gastric | 14 (41.2) | 13 (38.2) | |
| Lower gastric | 12 (35.3) | 12 (35.3) | |
| Tumor size (cm) | 4.5 ± 1.2 | 4.6 ± 1.3 | 0.70 |
| Tumor stage | |||
| Stage I | 10 (29.4) | 11 (32.4) | 0.85 |
| Stage II | 15 (44.1) | 14 (41.2) | |
| Stage III | 9 (26.5) | 9 (26.5) |
The study compared surgical outcomes between 16 patients in the naked-eye 3D group and 52 patients in the glass 3D group. The surgical approach distribution was similar between the groups, with distal gastrectomy being more common than total gastrectomy in both groups. The operative parameters were comparable, with median surgical times of approximately 195-196 minutes and relatively low intraoperative blood loss (median 20 mL vs 40 mL) in both groups. Postoperative recovery metrics showed remarkable consistency between the groups. Both experienced similar times to the first flatus (median 2 days), initiation of a semiliquid diet (6 days), and length of hospital stay (10-11 days). The extent of lymph node dissection was also comparable, with both groups achieving adequate harvests (median 24-25 nodes). The complication rates were similar (18.8% vs 15.4%), and patient-reported outcomes were not significantly different. Postoperative pain scores on the visual analogue scale were comparable (3.5 vs 3.8), as were quality of life scores (75 vs 76). Notably, all the comparisons yielded P values greater than 0.05, indicating that there were no statistically significant differences between the groups across all the measured parameters (Table 2).
| Characteristic | Naked-eye 3D gastric cancer group (n = 16) | Glass 3D gastric cancer group (n = 52) | P value |
| Surgical methods | |||
| Distal gastrectomy | 11 | 31 | > 0.05 |
| Total gastrectomy | 5 | 21 | > 0.05 |
| Surgical time (minute) | 195 (169, 214) | 196 (173, 222) | > 0.05 |
| Intraoperative bleeding volume (mL) | 20 (10, 90) | 40 (20, 100) | > 0.05 |
| Postoperative first anal exhaust time (day) | 2 (2, 3) | 2 (2, 3) | > 0.05 |
| Time of first postoperative intake of semiliquid food (day) | 6 (5.7) | 6 (5.6) | > 0.05 |
| Postoperative hospitalization time (day) | 10 (9, 14) | 11 (9, 14) | > 0.05 |
| Lymph node dissection number | 24 (20, 28) | 25 (22, 29) | > 0.05 |
| Postoperative complications, n (%) | 3 (18.8) | 8 (15.4) | > 0.05 |
| Postoperative pain score (VAS) | 3.5 (2, 4) | 3.8 (3, 5) | > 0.05 |
| Postoperative quality of life score | 75 (70, 80) | 76 (72, 81) | > 0.05 |
The analysis of tumor characteristics and staging revealed comparable patterns between the naked-eye 3D and glass 3D gastric cancer groups. The tumor size was similar between the groups, with median diameters of 3.0 cm in the naked-eye group and 3.5 cm in the glass group. In both groups, T4-stage tumors predominated, although cases were distributed across all T stages (T1-T4).
The evaluation of tumor invasion patterns revealed balanced distributions between groups. Half of the patients in the naked-eye 3D group exhibited vascular invasion, whereas approximately one-third of those in the glass 3D group exhibited vascular invasion. Neurological invasion was observed in approximately one-third of the naked-eye 3D cases and slightly less than half of the glass 3D cases. Cancer nodules were relatively uncommon, appearing in only two patients from each group. A notable finding emerged in the lymph node assessment. While the total number of harvested lymph nodes was comparable between the groups (median of 28 and 29 nodes), the naked-eye 3D group demonstrated significantly greater numbers of positive lymph nodes (median of 6 vs 1, P < 0.05). This represented the only statistically significant difference in pathological findings between the groups.
Tumor-node-metastasis clinical staging revealed somewhat different distribution patterns between the groups. The naked-eye 3D group presented a predominance of stage III disease (9/16 cases), whereas the glass 3D group presented a greater proportion of stage I cases (21/52). Advanced disease was rare, with only a single stage IV case observed in the glass 3D group (Table 3).
| Characteristic | Naked-eye 3D gastric cancer group (n = 16) | Glass 3D gastric cancer group (n = 52) | P value |
| Tumor diameter (cm) | 3.0 (2.0, 5.0) | 3.5 (2.0, 6.0) | > 0.05 |
| Tumor T staging | > 0.05 | ||
| T1 | 5 | 13 | |
| T2 | 3 | 10 | |
| T3 | 1 | 4 | |
| T4 | 7 | 25 | |
| Vascular invasion | > 0.05 | ||
| No | 8 | 33 | |
| Yes | 8 | 19 | |
| Neurological invasion | > 0.05 | ||
| No | 11 | 29 | |
| Yes | 5 | 23 | |
| Cancer nodules | > 0.05 | ||
| No | 14 | 50 | |
| Yes | 2 | 2 | |
| Tumor N staging | > 0.05 | ||
| N0 | 2 | 26 | |
| N1 | 3 | 6 | |
| N2 | 2 | 7 | |
| N3 | 4 | 13 | |
| Positive number of lymph nodes | 6 (1, 15) | 1 (0, 7) | < 0.05 |
| Total number of lymph node dissection | 28 (22, 43) | 29 (21, 39) | > 0.05 |
| Clinical staging of TNM | > 0.05 | ||
| Phase I | 4 | 21 | |
| Phase II | 3 | 10 | |
| Phase III | 9 | 20 | |
| Phase IV | 0 | 1 |
The study compared surgical outcomes between 19 patients in the naked-eye 3D group and 78 patients in the glass 3D group. The distribution of surgical procedures revealed a predominance of rectal cancer surgeries in the naked-eye group (12/19 patients), whereas colon cancer procedures were more common in the glass 3D group (40/78 patients). The operative parameters demonstrated remarkable consistency between the groups. The median surgical duration was comparable (132 minutes vs 124 minutes), with similarly low intraoperative blood loss (20 mL vs 25 mL). Both groups exhibited equivalent postoperative recovery trajectories, with patients achieving their first flatus at a median of 2 days and initiating a semiliquid diet on fifth day. Hospital stays were identical, with a median of 8 days for both groups. The quality indicators strongly aligned between the groups. Lymph node harvest was adequate in both groups (median 18 vs 20 nodes), and the complication rates were nearly identical (21.1% vs 20.5%). Patient-reported outcomes were also similar, with comparable pain scores (3.2 vs 3.0 on the visual analogue scale) and quality of life measures (70 vs 72). The recovery milestones were consistent across the groups, with wound healing achieved at a median of 7 days in both groups and the initiation of postoperative chemotherapy occurring at similar intervals (21 days vs 22 days). Notably, all the parameters presented P values greater than 0.05, indicating that there were no statistically significant differences between the groups (Table 4).
| Characteristic | Naked-eye 3D colorectal cancer group | Glass 3D colorectal cancer group | P value |
| Surgical methods | > 0.05 | ||
| Radical surgery for colon cancer | 7 | 40 | |
| Radical resection of rectal cancer | 12 | 38 | |
| Surgical time (minute) | 132 (97, 156) | 124 (110, 159) | > 0.05 |
| Intraoperative bleeding volume (mL) | 20 (10, 50) | 25 (15, 65) | > 0.05 |
| Postoperative first anal exhaust time (day) | 2 (1.3) | 2 (1, 3) | > 0.05 |
| Time of first postoperative intake of semiliquid food (day) | 5 (5, 6) | 5 (4, 6) | > 0.05 |
| Postoperative hospitalization time (day) | 8 (7, 10) | 8 (6, 10) | > 0.05 |
| Lymph node dissection number | 18 (15, 22) | 20 (17, 25) | > 0.05 |
| Postoperative complications, n (%) | 4 (21.1) | 16 (20.5) | > 0.05 |
| Postoperative pain score (VAS) | 3.2 (2, 4) | 3.0 (2, 3) | > 0.05 |
| Postoperative quality of life score | 70 (65, 75) | 72 (68, 76) | > 0.05 |
| Postoperative chemotherapy initiation time (day) | 21 (18, 24) | 22 (19, 25) | > 0.05 |
| Postoperative wound healing time (day) | 7 (6, 8) | 7 (5, 9) | > 0.05 |
Pathological analysis revealed comparable characteristics between the naked-eye 3D (n = 19) and glass 3D (n = 78) colorectal cancer groups. The tumor sizes were similar, with median diameters of 5.0 cm and 4.0 cm. The T stage distribution revealed that the T3 and T4 stages predominated in the naked-eye group (14/19 patients), whereas T3 stages were most common in the glass 3D group (43/78 patients).
Invasion patterns were relatively infrequent in both groups. Vascular invasion was observed in only 3/19 patients in the naked-eye group and 14/78 in the glass group, whereas neurological invasion was even rarer (2/19 and 12/78 patients, respectively). Cancer nodules were uncommon, appearing in just one patient in the naked-eye group and seven patients in the glass group. Lymph node assessment revealed similar patterns between the groups. The median number of positive lymph nodes was 0 in both groups, with comparable total number of harvested lymph nodes (median 17 vs 16 nodes). The majority of patients in both groups achieved qualified lymph node dissection standards (18/19 and 74/78 patients, respectively). Tumor-node-metastasis staging revealed stage III disease as the most common disease in both groups (12/19 in the naked-eye group, 40/78 in the glass group), followed by stage II and stage I. Notably, all the comparative analyses yielded P values greater than 0.05, indicating that there were no statistically significant differences in the pathological findings between the groups (Table 5).
| Characteristic | Naked-eye 3D gastric cancer group (n = 19) | Glass 3D gastric cancer group (n = 78) | P value |
| Tumor diameter (cm) | 5.0 (3.0, 6.0) | 4.0 (3.0, 5.0) | > 0.05 |
| Tumor T staging | > 0.05 | ||
| T1 | 3 | 7 | |
| T2 | 2 | 16 | |
| T3 | 7 | 43 | |
| T4 | 7 | 12 | |
| Vascular invasion | > 0.05 | ||
| No | 16 | 64 | |
| Yes | 3 | 14 | |
| Neurological invasion | > 0.05 | ||
| No | 17 | 66 | |
| Yes | 2 | 12 | |
| Cancer nodules | > 0.05 | ||
| No | 18 | 71 | |
| Yes | 1 | 7 | |
| Tumor N staging | > 0.05 | ||
| N0 | 8 | 46 | |
| N1-N2 | 11 | 32 | |
| Positive number of lymph nodes | 0 (0, 4) | 0 (0, 1) | > 0.05 |
| Total number of lymph node dissection | 17 (14, 23) | 16 (13, 19) | > 0.05 |
| Number of qualified lymph node dissection | > 0.05 | ||
| Yes | 18 | 74 | |
| No | 1 | 4 | |
| Clinical staging of TNM | > 0.05 | ||
| Phase I | 2 | 14 | |
| Phase II | 3 | 17 | |
| Phase III | 12 | 40 |
The study compared surgical and pathological outcomes between the naked-eye 3D (n = 35) and glass-based 3D (n = 130) groups, revealing several significant differences. The naked-eye 3D group had longer operative times [165 (135, 205) minutes vs 155 (125, 185) minutes, P < 0.05] and greater intraoperative blood loss [30 (15, 70) mL vs 20 (10, 50) mL, P < 0.05]. While both groups reported no conversions to open surgery, mortalities, or reoperations within 30 days, the naked-eye 3D group demonstrated a higher complication rate (22.9% vs 11.5%, P < 0.05). Postoperative recovery metrics also differed significantly. The naked-eye 3D group presented slightly delayed recovery milestones, including a longer time to first flatus [2.5 (2, 3) days vs 2 (1, 3) days, P < 0.05], later initiation of a semiliquid diet [5.5 (5, 7) days vs 5 (4, 6) days, P < 0.05], and extended hospital stays [9 (8, 11) days vs 8 (7, 9) days, P < 0.05]. Lymph node assessment revealed fewer harvests in the naked-eye 3D group, with fewer dissected nodes [17 (14, 20) vs 21 (18, 24), P < 0.05] and a greater number of positive nodes [2 (0, 5) vs 1 (0, 3), P < 0.05]. The total number of dissected lymph nodes was also lower [16 (13, 19) vs 18 (15, 22), P < 0.05], with a slightly lower rate of qualified lymph node dissection (91.4% vs 96.9%, P < 0.05; Table 6).
| Characteristic | Naked-eye 3D group (n = 35) | Glasses 3D group (n = 130) | P value |
| Operative time (minute) | 165 (135, 205) | 155 (125, 185) | < 0.05 |
| Intraoperative blood loss (mL) | 30 (15, 70) | 20 (10, 50) | < 0.05 |
| Conversion to open surgery | 0 (0) | 0 (0) | |
| 30-day mortality | 0 (0) | 0 (0) | |
| 30-day reoperation | 0 (0) | 0 (0) | |
| Complication rate | 8 (22.9) | 15 (11.5) | < 0.05 |
| Postoperative first anal exhaust time (day) | 2.5 (2, 3) | 2 (1, 3) | < 0.05 |
| Time of first postoperative intake of semiliquid food (day) | 5.5 (5, 7) | 5 (4, 6) | < 0.05 |
| Postoperative hospitalization time (day) | 9 (8, 11) | 8 (7, 9) | < 0.05 |
| Lymph node dissection number | 17 (14, 20) | 21 (18, 24) | < 0.05 |
| Positive number of lymph nodes | 2 (0, 5) | 1 (0, 3) | < 0.05 |
| Total number of lymph node dissection | 16 (13, 19) | 18 (15, 22) | < 0.05 |
| Number of qualified lymph node dissection | 32 (91.4) | 126 (96.9) | < 0.05 |
The analysis revealed several significant advantages of the glasses 3D system over the naked-eye 3D system across multiple clinical domains. In terms of operative performance, the glasses 3D group demonstrated superior surgical efficiency, with significantly shorter operative times [155 (125, 185) minutes vs 165 (135, 205) minutes, P < 0.05] and reduced intraoperative blood loss [20 (10, 50) mL vs 30 (15, 70) mL, P < 0.05]. Postoperative recovery metrics consistently favored the glasses 3D group, with patients experiencing earlier return of bowel function, as evidenced by a shorter time to first flatus [2 (1, 3) days vs 2.5 (2, 3) days, P < 0.05] and earlier initiation of a semiliquid diet [5 (4, 6) days vs 5.5 (5, 7) days, P < 0.05]. This translated to shorter overall hospital stays [8 (7, 9) days vs 9 (8, 11) days, P < 0.05]. Notably, the glasses 3D group presented a significantly lower complication rate (11.5% vs 22.9%, P < 0.05). The oncological adequacy of surgery also appeared superior in the glasses 3D group, as demonstrated by more comprehensive lymph node harvests [21 (18, 24) vs 17 (14, 20) nodes, P < 0.05] and a higher rate of qualified lymph node dissection (96.9% vs 91.4%, P < 0.05). The total number of lymph nodes retrieved was also greater in the glasses 3D group [18 (15, 22) vs 16 (13, 19), P < 0.05], although this group had a lower positive lymph node count [1 (0, 3) vs 2 (0, 5), P < 0.05; Table 7].
| Characteristic | Naked-eye 3D group (n = 35) | Glasses 3D group (n = 130) | P value |
| Postoperative infection rate | 12.9% (4/31) | 11.5% (15/130) | > 0.05 |
| Wound infection | 2 (5.7) | 2 (1.5) | < 0.05 |
| Urinary tract infection | 2 (5.7) | 3 (2.3) | > 0.05 |
| Pulmonary infection | 1 (2.9) | 1 (0.8) | > 0.05 |
| Anastomotic leak | 1 (2.9) | 3 (2.3) | > 0.05 |
| Postoperative fever (≥ 38 °C) | 8 (22.9) | 5 (3.8) | < 0.05 |
| C-reactive protein levels (mg/L) | 7.5 (5.0, 10.0) | 6.0 (4.0, 8.0) | < 0.05 |
| White blood cell count (× 109/L) | 10.5 (9.0, 12.0) | 9.5 (8.0, 11.0) | < 0.05 |
| Postoperative pain score (VAS) | 3.5 (2, 4) | 2.5 (2, 3) | < 0.05 |
| Pain management satisfaction | 3.0 (2.5, 3.5) | 3.5 (3.0, 4.0) | < 0.05 |
| Postoperative nutritional status (SGA) | 2.8 (2.0, 3.0) | 2.2 (1.5, 2.5) | < 0.05 |
| 6-minute walk test distance (m) | 350 (300, 400) | 400 (350, 450) | < 0.05 |
Laparoscopic surgery represents a revolutionary advancement in surgical history, fundamentally transforming both surgical practice and patient care paradigms. The introduction of 3D visualization systems in the 1990s marked a significant leap forward from traditional 2D laparoscopy, demonstrating substantial improvements in surgical precision and operational efficiency. This technological progression has gained such prominence that medical communities in both China and European countries have established comprehensive guidelines endorsing 3D laparoscopic systems as fundamental tools in minimally invasive surgery[16-18].
Despite their widespread adoption, contemporary naked-eye 3D systems face several significant technical constraints. A primary limitation lies in their partial implementation within the surgical team, while the primary surgeon operates without glasses, other team members, including assistants, instrument nurses, and lens holders, must still rely on polarized eyewear. This dichotomy in visualization methods potentially undermines the system’s overall efficiency gains. Furthermore, current technological limitations manifest in several operational aspects: Restricted resolution capabilities, inability to adjust viewing angles through lens rotation, and strict requirements for maintaining the optimal distance between the lens and surgical target. These constraints place considerable demands on surgical team coordination, particularly for the accuracy of the positioning of the lens holder[19-24].
This investigation into the application of naked-eye 3D systems in gastric cancer surgery revealed no substantial advantages over traditional glasses-based 3D systems in terms of safety, feasibility, or surgical outcomes[25]. This equivalence can be attributed to several factors. First, the limited scope of the benefits of the naked-eye system, which primarily affects only the lead surgeon, fails to enhance overall surgical team efficiency. Second, in this study, the procedures were performed by a highly experienced surgeon with extensive expertise in radical gastric surgery and thorough familiarity with anatomical structures. In this context, the enhanced visualization provided by the naked-eye system did not significantly impact surgical performance. Additionally, the nature of gastric cancer procedures, which typically involve less intricate suturing work, may not fully highlight the potential advantages of naked-eye 3D visualization.
Similar patterns emerged in this analysis of colorectal cancer procedures. While the literature has established the superiority of 3D laparoscopy over 2D systems in terms of operative time, blood loss, lymph node harvest, and specimen quality, the comparison between naked-eye and glasses-based 3D systems revealed no significant differences in surgical safety, feasibility, or pathological outcomes. This equivalence may be particularly relevant in colorectal procedures, which typically have shorter operative times than gastric surgery does, potentially minimizing the impact of glasses-related fatigue. Moreover, for surgeons already proficient in 3D laparoscopic techniques, the incremental improvements in visualization offered by naked-eye systems may not substantially influence surgical performance[26-28].
While this single-surgeon study design enhanced internal validity by eliminating operator variability, it also presented certain limitations. Notably, this approach precluded a comprehensive evaluation of surgeon ergonomics and visual fatigue across different surgical team members. Current technological constraints also limit our ability to assess comparative visual strain among surgical staff. These aspects, along with the nonrandomized, retrospective nature of this study and its relatively small sample size, suggest areas for future research. The observed difference in positive lymph node counts between groups, while noteworthy, did not translate to significant differences in overall lymph node harvest or qualification rates, indicating comparable oncological adequacy between the two systems.
In conclusion, while both systems demonstrate safety and efficacy in gastrointestinal cancer surgery, the current glasses-based 3D system appears to offer superior operative and postoperative outcomes. These findings may help inform surgical teams in their selection of visualization systems for minimally invasive gastrointestinal cancer procedures.
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