A systematic review and meta‐analysis of robotic resections for diverticular disease

Abstract

Aim: Resection of diverticular disease can be technically challenging. Tissue planes can be difficult to identify intraoperatively due to inflammation or fibrosis. Robotic surgery may improve identification of tissue planes and dissection which can facilitate difficult minimally invasive resections. This systematic review and meta-analysis evaluates the role of robotic surgery compared to laparoscopic surgery in diverticular resection. Methods:A systematic review and meta-analysis was performed in accordance with the PRISMA statement. The search was completed using PubMed, OVID MEDLINE and EMBASE. A total of 490 articles were retrieved, and studies reporting primary outcomes for robotic diverticular resection were included in the final analysis. A meta-analysis of studies comparing robotic and laparoscopic surgery was performed on rate of conversion to open surgery and complications.Results: Fifteen articles (8 cohort studies and 7 case series) reporting 3711 robotic diverticular resections were analysed. In comparison to laparoscopic, robotic surgery for diverticular disease was associated with a reduced conversion to open and a longer operating time. Meta-analysis showed robotic resection was associated with a lower conversion rate compared to laparoscopic surgery (OR: 0.57; 95% CI: 0.49-0.66, p < 0.001). There was no significant difference in grade III and above complications (OR: 0.74; 95% CI: 0.49-1.13, p = 0.17). Operating time was longer with a robotic approach (Hedge's G: 0.43; 95% CI: 0.04-0.81, p = 0.03). Conclusion:Robotic resection is a feasible and safe option in diverticular disease.Although associated with a longer operating time, robotic surgery may render diverticular disease resectable with a minimally invasive approach that would have otherwise necessitated a laparotomy. Randomised controlled data is required to better define the role of robotic surgery for diverticular disease resections.

A retrospective audit of Robotic versus Laparoscopic Anterior Resection for diverticular disease in a Single Surgeon’s Experience

“…The newer da Vinci Xi® was subsequently easier to dock and set up. In the systematic review by Larkins et al [9], operating time was longer with a robotic approach (p = 0.03) compared to laparoscopic approach [9]. Our study however demonstrated no signi cant difference in operating time in the laparoscopic and robotic anterior resection group (p = 0.095).…”

“…However, more current studies have demonstrated signi cant reductions in length of stay, conversion to open surgery rate, and hospital costs for surgeons performing a high volume of robotic surgery [4]. A recent systematic review of robotic resections in diverticular disease demonstrated that robotic surgery for diverticular disease was associated with a reduced conversion to open surgery, but a longer operating time as compared to laparoscopic surgery [9]. In another study comparing outcomes of robotic versus laparoscopic colorectal surgery for both benign and malignant conditions, performed by surgeons experienced in both robotic and laparoscopic procedures, they found no statistical difference in length of stay, time to return of bowel function, and time to discontinuation of patient-controlled analgesia [10].…”

Evaluation of heterogeneity in meta‐analysis

“…Disease [1], and I congratulate the authors. However, I have some comments on the methodology used in this meta-analysis.…”

“…The authors concluded that robotic surgery gives lower conversion (in all cases). They mentioned in the discussion section that 'The key findings from the data examined are that conversion rate is lower with a robotic approach while …' [1]. They considered that there was no heterogeneity.…”

Feasibility and safety of a robotic approach to diverticular disease: a retrospective series of short‐term outcomes

“…A recently published systematic review of colorectal resections for diverticular disease has shown a lower conversion rate in robotic surgery in comparison to laparoscopic surgery at the expense of longer operating time. 5 There is a paucity of data reporting on robotic resections for diverticular disease in Australasia. The aim of this current study is to report on safety and feasibility of robotic colorectal resection for diverticular disease in an Australian context.…”