Robotic right colectomy: A worthwhile procedure? Results of a meta-analysis of trials comparing robotic versus laparoscopic right colectomy

Abstract

BACKGROUND:Robotic right colectomy (RRC) is a complex procedure, offered to selected patients at institutions highly experienced with the procedure. It is still not clear if this approach is worthwhile in enhancing patient recovery and reducing post-operative complications, compared with laparoscopic right colectomy (LRC). Literature is still fragmented and no meta-analyses have been conducted to compare the two procedures. This work aims at reducing this gap in literature, in order to draw some preliminary conclusions on the differences and similarities between RRC and LRC, focusing on short-term outcomes.MATERIALS AND METHODS:A systematic literature review was conducted to identify studies comparing RRC and LRC, and meta-analysis was performed using a random-effects model. Peri-operative outcomes (e.g., morbidity, mortality, anastomotic leakage rates, blood loss, operative time) constituted the study end points.RESULTS:Six studies, including 168 patients undergoing RRC and 348 patients undergoing LRC were considered as suitable. The patients in the two groups were similar with respect to sex, body mass index, presence of malignant disease, previous abdominal surgery, and different with respect to age and American Society of Anesthesiologists score. There were no statistically significant differences between RRC and LRC regarding estimated blood loss, rate of conversion to open surgery, number of retrieved lymph nodes, development of anastomotic leakage and other complications, overall morbidity, rates of reoperation, overall mortality, hospital stays. RRC resulted in significantly longer operative time.CONCLUSIONS:The RRC procedure is feasible, safe, and effective in selected patients. However, operative times are longer comparing to LRC and no advantages in peri-operative and post-operative outcomes are demonstrated with the use of the robotic surgical system.

Reviewing the Comparison of Robotic Colectomy with the Laparoscopic Ones of All the Procedures based on Determined Parameters

“…The first one was recently conducted from the Surgery Department of Sapienza University and compared the indications, surgical and oncologic outcomes, and costs of RRC with the LRC ones. 17 The EBL, the conversion to open procedure, the number of retrieved lymph nodes were similar in both of them. 17 Unimportant statistical differences were presented regarding LOS and the overall complications.…”

“…17 The EBL, the conversion to open procedure, the number of retrieved lymph nodes were similar in both of them. 17 Unimportant statistical differences were presented regarding LOS and the overall complications. 17 The RRC entails more expenses than LRC, although the difference is still not statistically important.…”

“…17 We included three meta-analyses in our research. 4,7,17 Cumulatively, these three studies include 30 comparative studies, in which 1,322 patients underwent RRC and 4,185 were treated with LRC. The first one was recently conducted from the Surgery Department of Sapienza University and compared the indications, surgical and oncologic outcomes, and costs of RRC with the LRC ones.…”

“…[9][10][11][12][13][14][15] However, robotic surgery (RS) has been recently introduced as a new contemporary alternative because of its obvious advantages, including the three-dimensional view, the ability to use multidegree-of-freedom forceps, the elimination of physiological tremors, and the stable camera control, in order to broaden the horizons of MIS. [3][4][5][16][17][18][19] Initially, it was expected that RS would dominate the field of MIS related to colorectal surgery because of its obvious structural advantages and due to the limited space in the pelvis for the laparoscopic instruments and the restricted potential of movements even for an experienced surgeon to perform rectal dissection. 3 However, it seems that there is no clear-cut answer in the literature determining the beneficial use of RS over LS in the field of colorectal cancer.…”

“…22 The first robotic colectomy was reported in 2002, and the use of robotic procedures has been increasing since then, while it has a more extensive use in the field of urology. 3,17,23,24 This is a retrospective comprehensive review of various publications comparing these two methods of surgical procedures separately and taking into consideration plenty of parameters, such as the clinical and the oncologic outcomes and how they can be affected, the body mass index (BMI), the total mean hospital costs for each procedure, and postoperative complications. Only studies that had classified their patients with similar criteria were taken into consideration (gender, BMI, American Society of Anesthesiologists [ASA] score, tumor location, previous abdominal surgery).…”