introduction / background

Video-assisted thoracoscopic surgery (VATS) lobectomy is commonly employed for stage I lung cancer resection.


In this study we compared ergonomical characteristics of three dimensional (3D) versus two dimensional (2D) system in VATS lobectomy using a scoring scale.

Materials & Methods

Thirty-four patients with stage I lung cancer were randomized (study power 0.80, α error=0.05) to undergo 2-ports VATS lobectomy by either 3D (group 1, N=17) or 2D (group 2, N=17) display systems (ClinicalTrials.gov ID: NCT03925103). All operations were recorded and divided into 5 surgical steps (vein, artery, bronchus, lymph nodes, fissure), which were evaluated by 3 thoracic surgeons using a new scoring scale (score range 1, unsatisfactory to 3 excellent) entailing 3 ergonomical domains: exposure, instrumentation and maneuvering. Primary outcome was a difference ≥10% (sd=0.3) in at least one evaluated domain.


There were 24 males and 10 females with a mean age of 69±6.9 years. Interobserver agreement using the scoring scale was good (ANOVA, P range 0.34-0.98), The coherence between ergonomic domains' scores was good (Cronbach's α, 0.74). The main study results are summarized in Table 1. There are significant differences favoring the 3D system were found in maneuvering of the vein, artery, bronchus and lymph nodes and in exposure of the vein and of the artery scores. Conversely, results favoring the 2D system regarded both exposure and instrumentation of the fissure. There were no differences in operation time, operative bleeding, total chest drainage volume and hospital stay.


Our study results suggest that at comparison of ergonomics of 3D versus 2D VATS lobectomy by a new scoring scale, the 3D system proved better for maneuvering and exposure of vascular structures possibly due to a better perception of depth, whereas the 2D system proved better for exposure and instrumentation of the fissure, possibly due to a lower magnification rate when dealing with lager surgical fields.


1. Whitson BA, Growth SS, Duval SJ, et al. Surgery for early-stage non-small cell lung cancer: a systematic review of the video-assisted thoracoscopic surgery versus thoracotomy approaches to lobectomy. Ann Thorac Surg 2008;86:2008 –18. 2. Elkhouly AG, Cristino B, Alhasan A, et al. Minimalist three-dimensional thoracoscopic extended thymomectomy in a patient with myasthenia gravis. J Vis Surg 2019; 5:49.

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