Caiwen Han1,2,3, Xinyi Shan1,3, Liang Yao3, Peijing Yan3, Meixuan Li4,3, Lidong Hu1,2,3, Hongwei Tian1, Wutang Jing1, Binbin Du1, Lixia Wang3, Kehu Yang5,6, Tiankang Guo7,8. 1. Department of General Surgery, Gansu Provincial Hospital, 204 Donggang West Road, Lanzhou, 730000, People's Republic of China. 2. Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, People's Republic of China. 3. Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, People's Republic of China. 4. School of Public Health, Lanzhou University, Lanzhou, 730000, People's Republic of China. 5. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China. kehuyangebm2006@126.com. 6. Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, People's Republic of China. kehuyangebm2006@126.com. 7. Department of General Surgery, Gansu Provincial Hospital, 204 Donggang West Road, Lanzhou, 730000, People's Republic of China. TiankangGuo2018@163.com. 8. Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, People's Republic of China. TiankangGuo2018@163.com.
Abstract
BACKGROUND: Robotic surgery, an emerging technology, has some potential advantages in many complicated endoscopic procedures compared with laparoscopic surgery. But robot-assisted cholecystectomy (RAC) is still a controversial issue on its comparative merit compared with conventional laparoscopic cholecystectomy (LC). The aim of this study was to evaluate the safety and efficacy of RAC compared with LC for benign gallbladder disease. METHODS: A systematic literature search was conducted using the PubMed, EMBASE, and Cochrane Library databases (from their inception to December 2017) to obtain comparative studies assessing the safety and efficacy between RAC and LC. The quality of the literature was assessed, and the data analyzed using R software, random effects models were applied. RESULTS: Twenty-six studies, including 5 RCTs and 21 NRCSs (3 prospective plus 18 retrospective), were included. A total of 4004 patients were included, of which 1833 patients (46%) underwent RAC and 2171 patients (54%) underwent LC. No significant differences were found in intraoperative complications, postoperative complications, readmission rate, hospital stay, estimated blood loss, and conversion rate between RAC and LC groups. However, RAC was related to longer operative time compared with LC (MD = 12.04 min, 95% CI 7.26-16.82) in RCT group, which was consistent with NRCS group; RAC also had a higher rate of incisional hernia in NRCS group (RR = 3.06, 95% CI 1.42-6.57), and one RCT reported that RAC was similar to LC (RR = 7.00, 95% CI 0.38-129.84). CONCLUSIONS: The RAC was not found to be more effective or safer than LC for benign gallbladder diseases, which indicated that RAC is a developing procedure instead of replacing LC at once. Given the higher costs, the current evidence is in favor of LC in cholecystectomy.
BACKGROUND: Robotic surgery, an emerging technology, has some potential advantages in many complicated endoscopic procedures compared with laparoscopic surgery. But robot-assisted cholecystectomy (RAC) is still a controversial issue on its comparative merit compared with conventional laparoscopic cholecystectomy (LC). The aim of this study was to evaluate the safety and efficacy of RAC compared with LC for benign gallbladder disease. METHODS: A systematic literature search was conducted using the PubMed, EMBASE, and Cochrane Library databases (from their inception to December 2017) to obtain comparative studies assessing the safety and efficacy between RAC and LC. The quality of the literature was assessed, and the data analyzed using R software, random effects models were applied. RESULTS: Twenty-six studies, including 5 RCTs and 21 NRCSs (3 prospective plus 18 retrospective), were included. A total of 4004 patients were included, of which 1833 patients (46%) underwent RAC and 2171 patients (54%) underwent LC. No significant differences were found in intraoperative complications, postoperative complications, readmission rate, hospital stay, estimated blood loss, and conversion rate between RAC and LC groups. However, RAC was related to longer operative time compared with LC (MD = 12.04 min, 95% CI 7.26-16.82) in RCT group, which was consistent with NRCS group; RAC also had a higher rate of incisional hernia in NRCS group (RR = 3.06, 95% CI 1.42-6.57), and one RCT reported that RAC was similar to LC (RR = 7.00, 95% CI 0.38-129.84). CONCLUSIONS: The RAC was not found to be more effective or safer than LC for benign gallbladder diseases, which indicated that RAC is a developing procedure instead of replacing LC at once. Given the higher costs, the current evidence is in favor of LC in cholecystectomy.
Authors: Rivfka Shenoy; Michael A Mederos; Linda Ye; Selene S Mak; Meron M Begashaw; Marika S Booth; Paul G Shekelle; Mark Wilson; William Gunnar; Melinda Maggard-Gibbons; Mark D Girgis Journal: Syst Rev Date: 2021-04-23