Perioperative, Pathologic, and Early Continence Outcomes Comparing Three-Dimensional and Two-Dimensional Display Systems for Laparoscopic Radical Prostatectomy— A Retrospective, Single-Surgeon Study Serdar Aykan, MD, 1 Paras Singhal, MD, 2 Daniel P. Nguyen, MD, 3 Akin Yigit, MD, 4 Murat Tuken, MD, 1 Emrah Yakut, MD, 1 Aykut Colakerol, MD, 1 Suhejb Sulejman, MD, 1 and Atilla Semercioz, MD 1 Abstract Purpose: To examine perioperative, pathologic, and early continence outcomes of laparoscopic radical pros- tatectomy (RP) aided by a new-generation three-dimensional (3D) display system and compare them with those from the same operation aided by a conventional, two-dimensional (2D) display system. Patients and Methods: A total of 95 consecutive patients underwent laparoscopic RP for clinically localized prostate cancer (PC) by an experienced single surgeon from October 2009 to December 2012. Baseline characteristics, perioperative and pathologic variables, and continence data at 3 months after surgery were retrospectively reviewed from a prospectively maintained database. Categoric and continuous variables were compared using chi-square, Student t, and Wilcoxon rank-sum tests, as appropriate. Results: A total of 29 patients underwent laparoscopic RP using a 3D display system and 66 patients underwent laparoscopic RP using a 2D display system. The two groups were comparable for all clinical and pathologic variables. Mean total operative time for the 3D group was 131 minutes (standard deviation [SD] – 18) compared with 190 (SD – 31) for the 2D group (P < 0.001). Mean time to perform the urethrovesical anastomosis was 28 minutes (SD – 6) for the 3D group compared with 87 minutes (SD – 17) for the 2D group (P < 0.001). Blood loss was lower in the 3D group, and the difference was statistically significant (P < 0.001). A statistically significant higher number of patients in the 3D group had early recovery of continence compared with patients in the 2D group (14/28 (50%) patients in the 3D group vs 16/64 (25%) patients in the 2D group, P = 0.02). Conclusions: Laparoscopic RP aided by a new-generation 3D display system is associated with shorter op- erative times, reduced blood loss, and higher early continence rates in comparison with that aided by a 2D display system. In particular when considering economic issues, 3D laparoscopic RP may represent an ac- ceptable alternative to robot-assisted laparoscopic RP. Introduction R adical prostatectomy (RP) remains the reference standard for the surgical management of clinically lo- calized prostate cancer (PC). 1,2 Since Hugh Hampton Young’s first description of radical perineal prostatectomy in 1905, 3 substantial efforts have been devoted to improving anatomic knowledge and surgical techniques to optimize the perioperative course as well as oncologic and functional outcomes. In this context, minimally invasive approaches including conventional and robot-assisted laparoscopic RP have gained increasing interest in recent years. In fact, early available evidence indicates that comparable results can be achieved with open, conventional, and robot-assisted RP in terms of perioperative, oncologic, and functional out- comes. 4,5 Conventional laparoscopic RP was first introduced in 1991. 6 Despite known advantages that include less postop- erative pain and shorter hospital stay, laparoscopic RP is a complex procedure that is limited by two-dimensional (2D) visualization and space constraint. The operation is therefore associated with a long learning curve. 7 Some of these 1 Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey. 2 Department of Urology, Weill Cornell Medical College, New York, New York. 3 Department of Urology, Berne University Hospital, Berne, Switzerland. 4 Department of Urology, Erzincan University School of Medicine, Erzincan, Turkey. JOURNAL OF ENDOUROLOGY Volume 28, Number 5, May 2014 ª Mary Ann Liebert, Inc. Pp. 539–543 DOI: 10.1089/end.2013.0630 539