Robotic versus laparoscopic left colectomy: a systematic review and meta-analysis

Abstract

Background This study aimed to review the new evidence to understand whether the robotic approach could find some clear indication also in left colectomy. Methods A systematic review of studies published from 2004 to 2022 in the Web of Science, PubMed, and Scopus databases and comparing laparoscopic (LLC) and robotic left colectomy (RLC) was performed. All comparative studies evaluating robotic left colectomy (RLC) versus laparoscopic (LLC) left colectomy with at least 20 patients in the robotic arm were included. Abstract, editorials, and reviews were excluded. The Newcastle–Ottawa Scale for cohort studies was used to assess the methodological quality. The random-effect model was used to calculate pooled effect estimates. Results Among the 139 articles identified, 11 were eligible, with a total of 52,589 patients (RLC, n = 13,506 versus LLC, n = 39,083). The rate of conversion to open surgery was lower for robotic procedures (RR 0.5, 0.5–0.6; p < 0.001). Operative time was longer for the robotic procedures in the pooled analysis (WMD 39.1, 17.3–60.9, p = 0.002). Overall complications (RR 0.9, 0.8–0.9, p < 0.001), anastomotic leaks (RR 0.7, 0.7–0.8; p < 0.001), and superficial wound infection (RR 3.1, 2.8–3.4; p < 0.001) were less common after RLC. There were no significant differences in mortality (RR 1.1; 0.8–1.6, p = 0.124). There were no differences between RLC and LLC with regards to postoperative variables in the subgroup analysis on malignancies. Conclusions Robotic left colectomy requires less conversion to open surgery than the standard laparoscopic approach. Postoperative morbidity rates seemed to be lower during RLC, but this was not confirmed in the procedures performed for malignancies.

Robotic versus laparoscopic approach for left‐sided colon cancer: a nationwide cohort study

“…Another study found a significantly higher LNY in robot-assisted right colectomy compared with laparoscopic right colectomy, but no differences in patients undergoing surgery for left-sided colon cancer [9]. This is consistent with the remaining relevant literature, where no differences in LNY [19] [10] [35] or in the proportion of patients with a LNY of 12 or more [36] are described. A higher LNY might be indicative of more central dissection using CME [27,29].…”

“…The most recent meta-analysis on the subject, including found. However, in a subgroup analysis on malignant cases only, the sole significant finding was a longer operating time for RLC [19].…”

“…No differences in other postoperative variables, mortality or LNY were found. However, in a subgroup analysis on malignant cases only, the sole significant finding was a longer operating time for RLC [19]. Another meta‐analysis (based on 12 retrospective studies, but only three single‐centre studies examining left colectomy or sigmoidectomy including a total of 355 patients) comparing robotic versus laparoscopic resection for both malignant and benign disease found a longer operating time, higher cost, less blood loss during surgery and shorter length of hospital stay following robotic surgery, but no differences in conversion to open surgery, anastomotic leak or LNY in the subgroup analysis on left‐sided colectomy or malignity cases alone [9].…”

Robotic-Assisted versus Laparoscopic Left Hemicolectomy—Postoperative Inflammation Status, Short-Term Outcome and Cost Effectiveness

“…In line with the results of the previous studies but with the focus on left hemicolectomy only, Giordano et al showed decreased rates of complications and readmissions for robotic-assisted surgery in comparison to laparoscopic surgery in sigmoid resection [ 17 ]. Those results were confirmed by a systematic review which demonstrated that rates of overall complications, anastomotic leakage and wound infections were decreased following robotic-assisted left hemicolectomy [ 18 ].…”

Implementation of a patient blood management in an Italian City Hospital: is it effective in reducing the use of red blood cells?

“…In the last 20 years, minimally invasive surgery has increasingly been used. Both laparoscopic and robotic surgery have demonstrated several advantages over “open” surgery; among these, the reduction of the intraoperative blood loss appears consistent [ 30 – 34 ]. In the present series, a significant increase in the use of the minimally invasive approach was evident, from 31 to 38% in the first and second periods, respectively.…”