Robotic versus Laparoscopic Approach in Colonic Resections for Cancer and Benign Diseases: Systematic Review and Meta-Analysis

Abstract

ObjectivesThe aim of this systematic review and meta-analysis is to compare robotic colectomy (RC) with laparoscopic colectomy (LC) in terms of intraoperative and postoperative outcomes.Materials and MethodsA systematic literature search was performed to retrieve comparative studies of robotic and laparoscopic colectomy. The databases searched were PubMed, Embase and the Cochrane Central Register of Controlled Trials from January 2000 to October 2014. The Odds ratio, Risk difference and Mean difference were used as the summary statistics.ResultsA total of 12 studies, which included a total of 4,148 patients who had undergone robotic or laparoscopic colectomy, were included and analyzed. RC demonstrated a longer operative time (MD 41.52, P<0.00001) and higher cost (MD 2.42, P<0.00001) than did LC. The time to first flatus passage (MD -0.51, P = 0.003) and the length of hospital stay (MD -0.68, P = 0.01) were significantly shorter after RC. Additionally, the intraoperative blood loss (MD -16.82, P<0.00001) was significantly less in RC. There was also a significantly lower incidence of overall postoperative complications (OR 0.74, P = 0.02) and wound infections (RD -0.02, P = 0.03) after RC. No differences in the postoperative ileus, in the anastomotic leak, or in the conversion to open surgery rate and in the number of harvested lymph nodes outcomes were found between the approaches.ConclusionsThe present meta-analysis, mainly based on observational studies, suggests that RC is more time-consuming and expensive than laparoscopy but that it results in faster recovery of bowel function, a shorter hospital stay, less blood loss and lower rates of both overall postoperative complications and wound infections.

The Surgical Robot: Applications and Advantages in General Surgery

“…Similar conclusions have been drawn from an extensive meta-analysis in 2015 comparing robotic versus laparoscopic colorectal resections, which also pointed out a lower incidence of peri-operative complications and surgical site infections [13].…”

Successful patient‐oriented surgical outcomes in robotic vs laparoscopic right hemicolectomy for cancer – a systematic review

“…The incidence of ileus was similar between RRH and LRH; however, in four studies passing of first flatus was reported to be significantly earlier in RRH (2.0–2.7 days vs 2.5–4.0 days). This finding has been previously highlighted in studies with a meta‐analysis analysing the robotic vs laparoscopic approach in colonic resection for both cancer and benign diseases . Trastulli et al .…”

The da Vinci Xi: a review of its capabilities, versatility, and potential role in robotic colorectal surgery

“…[10][11][12][13][14][15][16][17] In general, authors have found robotic surgery to be feasible and safe, referring to it as submit your manuscript | www.dovepress.com…”

“…A consistent conclusion in the majority of papers is that robotic colorectal surgery tends to be associated with a higher cost and a longer operative time. [13][14][15][16][17] However, the quality of these studies and consequently the conclusions drawn should be subjected to greater scrutiny. Most of these publications have been either case series or retrospective comparative studies.…”