Clinical efficacy and safety of 3D vascular reconstruction combined with 3D navigation in laparoscopic hepatectomy: systematic review and meta-analysis

Abstract

Background: Meta-analysis was used to compare the difference between 3D reconstruction technology and 2D computed tomography (CT) before surgery for primary hepatic carcinoma (PHC) and to systematically evaluate the application value of 3D vascular reconstruction and 3D navigation technology in guiding precise liver resection for PHC. However, there are still many controversies in this aspect, and there are no clear conclusions on the effectiveness and safety of three-dimensional vascular reconstruction combined with three-dimensional navigation in laparoscopic hepatectomy. Therefore, it is necessary to systematically review the results of previous studies with meta method in this study to determine their clinical efficacy and complications and guide clinical treatment. Methods: We used the Cochrane Library, PubMed, Embase, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodicals Full-Text Database (VIP), and Wanfang database to conduct an online search for data from randomized controlled trials of preoperative 3D reconstruction versus conventional CT in hepatectomy published up to October 2021. Relevant literature was selected based on the inclusion criteria, data was extracted, and quality evaluation of the included literature was carried out. I2 test was used to evaluate heterogeneity among the studies, and Cochrane risk of bias 2.0 was used to evaluate the studies. Results: A total of 16 studies were included in this study. Meta-analysis showed that there were statistically significant differences between the 3D vascular reconstruction group and conventional surgery group in operation time [mean differences (MD) =−40.10, 95% confidence interval (CI): −74.94, −5.26, P=0.02, I2=78%, Z=2.26] and intraoperative blood loss (MD =−50.40, 95% CI: −62.93, −37.86, P<0.00001, I2=9%, Z=7.88), but no statistically significant difference was found in total days in hospital (MD =−0.39, 95% CI: −1.81, 1.03, P=0.59, I2=76%, Z=0.54), and postoperative complications rate (OR =0.98, 95% CI: 0.64, 1.50, P=0.91, I2=0%, Z=0.11). Discussion: Preoperative 3D reconstruction plays an important role in preoperative evaluation and surgical planning, which improves the operation time of PHC and reduces the intraoperative blood loss, but no effect to length of stay in hospital or complication rate comparing to conventional 2D techniques.