The benefits and harms of three dimensional imaging (3D) versus traditional two dimensional (2D) imaging for key hole removal of the gallbladder (laparoscopic cholecystectomy) is not known. We set out to assess the benefits and harms of use of three dimensional systems versus two dimensional systems during laparoscopic cholecystectomy. We searched various medical databases and trials registers until October 2010 for identifying randomised clinical trials irrespective of language, blinding, or publication status.

Two authors independently identified trials and independently extracted data. We performed all the analysis based on intention-to-treat analysis. One trial randomised 60 patients to three dimensional laparoscopic cholecystectomy (n = 30) compared with standard two dimensional laparoscopic cholecystectomy (n = 30). The report on the trial design revealed high risk of systematic error ('bias'). There were no post-operative complications or conversion to open cholecystectomy in either group. There was no difference in the operating time or number of surgical errors between the two groups. Currently, there is no evidence that three dimensional image is superior to two dimensional image in laparoscopic cholecystectomy. Further randomised clinical trials with low risk of systematic errors and random errors are necessary to assess the new systems of three dimensional imaging in comparison with two dimensional imaging.