Robotic versus conventional laparoscopic distal pancreatic resection: a systematic review and meta-analysis

Kamarajah, Sivesh K.; Sutandi, Nathania; Robinson, Stuart; French, Jeremy; White, Steven A.

doi:10.1016/j.hpb.2019.02.020

Cited by 52 publications

(60 citation statements)

References 44 publications

(28 reference statements)

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“…Statistical significance was considered when p < 0.05. Statistical analyses were performed using the R Foundation Statistical software (R 3.2.1) and Stata 15 (Version 15.1, StataCorp, College Station, Texas) as previously described (2,18).…”

Section: Discussionmentioning

confidence: 99%

“…Inclusion criteria were as follows: (1) studies comparing the use of robotic and laparoscopic for liver resections for benign and malignant indications and (2) published in the English language. Exclusion criteria were as follows: (1) conference abstracts, review articles, and case reports (<5 patients), (2) non-comparative analysis between minimally invasive surgery, and (3) studies where outcomes were not reported separately for robotic and laparoscopic surgery. After excluding duplicates, two researchers (S.K.K., J.B.) independently reviewed the titles and abstracts of studies identified by the literature search.…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

“…Robotic surgery has been shown to be superior to conventional laparoscopic surgery in a variety of different complex surgical procedures. For instance, robotic surgery for distal pancreatectomy is associated with significantly lower conversion rates and shorter hospital stay compared to laparoscopic surgery (2).…”

Section: Introductionmentioning

confidence: 99%

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Robotic versus conventional laparoscopic liver resections: A systematic review and meta-analysis

et al. 2020

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Background: Theoretical advantages of robotic surgery compared to conventional laparoscopic surgery include improved instrument dexterity, 3D visualization, and better ergonomics. This systematic review and meta-analysis aimed to determine advantages of robotic surgery over laparoscopic surgery in patients undergoing liver resections. Method: A systematic literature search was conducted for studies comparing robotic assisted or totally laparoscopic liver resection. Meta-analysis of intraoperative (operative time, blood loss, transfusion rate, conversion rate), oncological (R0 resection rates), and postoperative (bile leak, surgical site infection, pulmonary complications, 30-day and 90-day mortality, length of stay, 90-day readmission and reoperation rates) outcomes was performed using a random effects model. Result: Twenty-six non-randomized studies including 2630 patients (950 robotic and 1680 laparoscopic) were included, of which 20% had major robotic liver resection and 14% had major laparoscopic liver resection. Intraoperatively, robotic liver resection was associated with significantly less blood loss (mean: 286 vs 301 mL, p < 0.001) but longer operating time (mean: 281 vs 221 min, p < 0.001). There were no significant differences in conversion rates or transfusion rates between robotic liver resection and laparoscopic liver resection. Postoperatively, there were no significant differences in overall complications, bile leaks, and length of hospital stay between robotic liver resection and laparoscopic liver resection. However, robotic liver resection was associated with significantly lower readmission rates than laparoscopic liver resection (odds ratio: 0.43, p = 0.005). Conclusion: Robotic liver resection appears to offer some advantages compared to conventional laparoscopic surgery, although both techniques appear equivalent. Importantly, the quality of evidence is generally limited to cohort studies and a high-quality randomized trial comparing both techniques is needed.

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Section: Discussionmentioning

confidence: 99%

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

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Robotic versus conventional laparoscopic liver resections: A systematic review and meta-analysis

et al. 2020

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“…Statistical significance was considered when p < 0.05. Statistical analyses were performed using the RevMan 5.3 software (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011) and R statistical software (Version 3.5.2, R Foundation for Statistical Computing, Vienna, Austria) as previously described [16,17].…”

Section: Methodsmentioning

confidence: 99%

Perioperative outcomes after laparoscopic cholecystectomy in elderly patients: a systematic review and meta-analysis

et al. 2020

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Background Laparoscopic cholecystectomy is increasingly performed in an ever ageing population; however, the risks are poorly quantified. The study aims to review the current evidence to quantify further the postoperative risk of cholecystectomy in the elderly population compared to younger patients. Method A systematic literature search of PubMed, EMBASE and the Cochrane Library databases were conducted including studies reporting laparoscopic cholecystectomy in the elderly population. A meta-analysis was reported in accordance with the recommendations of the Cochrane Library and PRISMA guidelines. Primary outcome was overall complications and secondary outcomes were conversion to open surgery, bile leaks, postoperative mortality and length of stay. Results This review identified 99 studies incorporating 326,517 patients. Increasing age was significantly associated with increased rates of overall complications (OR 2.37, CI95% 2.00–2.78), major complication (OR 1.79, CI95% 1.45–2.20), risk of conversion to open cholecystectomy (OR 2.17, CI95% 1.84–2.55), risk of bile leaks (OR 1.50, CI95% 1.07–2.10), risk of postoperative mortality (OR 7.20, CI95% 4.41–11.73) and was significantly associated with increased length of stay (MD 2.21 days, CI95% 1.24–3.18). Conclusion Postoperative outcomes such as overall and major complications appear to be significantly higher in all age cut-offs in this meta-analysis. This study demonstrated there is a sevenfold increase in perioperative mortality which increases by tenfold in patients > 80 years old. This study appears to confirm preconceived suspicions of higher risks in elderly patients undergoing cholecystectomy and may aid treatment planning and informed consent.

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“…For all analyses, a P ‐value <0.05 was considered statistically significant. Data analysis was undertaken using R Foundation Statistical Software (R 3.2.1, R Foundation for Statistical Computing, Vienna, Austria) as previously described …”

Section: Methodsmentioning

confidence: 99%

Is water‐soluble contrast enema examination for integrity of rectal anastomosis necessary prior to ileostomy reversal?

et al. 2019

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Background and Aim Routine use of water‐soluble contrast enema (WSCE) to assess anastomotic integrity is debated. This study aimed to evaluate the role of WSCE to assess anastomotic integrity following anterior resections (AR) with defunctioning stoma prior to reversal and identify factors to limit its selective use. Methods This retrospective study evaluated all WSCE performed over a 7‐year period at a high‐volume colorectal unit. Risk factors for radiological abnormality/leak, including malignancy, chemoradiotherapy, and immediate postoperative complications, were recorded. A gastrointestinal specialist radiologist and surgeon validated all WSCEs reported as abnormal. Results Of the 486 WSCE studies identified, 92 were excluded (repeat studies (n = 51), pediatric cases [n = 2], no AR [n = 39]). A total of 394 WSCE studies were evaluated (260 cancer; 134 noncancer patients); 14% (37/260) of cancer patients and 8% (10/134) of noncancer patients had abnormal studies (P = 0.072). Of the 37 abnormal studies in cancer patients, 73% (27/37) radiological leaks were found, and 41% (n = 11/27) of these patients had postoperative complications. Of the 10 abnormal studies in noncancer patients, 20% (2/10) radiological leaks were found, but none of these patients had postoperative complications. Overall leak rates were 7% (29/394), and rates were significantly higher in cancer patients than noncancer patients (10 vs 2%, P = 0.005). Conclusion Routine use of WSCE may not be necessary prior to reversal. WSCE should be selectively used in event of postoperative leak or complications. Noncancer resections are less likely demonstrate a leak.

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Robotic versus conventional laparoscopic distal pancreatic resection: a systematic review and meta-analysis

Cited by 52 publications

References 44 publications

Robotic versus conventional laparoscopic liver resections: A systematic review and meta-analysis

Robotic versus conventional laparoscopic liver resections: A systematic review and meta-analysis

Perioperative outcomes after laparoscopic cholecystectomy in elderly patients: a systematic review and meta-analysis

Is water‐soluble contrast enema examination for integrity of rectal anastomosis necessary prior to ileostomy reversal?

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