Robotic versus laparoscopic right colectomy: a meta-analysis

Abstract

BackgroundThe objective of this meta-analysis was to compare the clinical safety and efficacy of robotic right colectomy (RRC) with conventional laparoscopic right colectomy (LRC).MethodsA literature search was performed for comparative studies reporting perioperative outcomes of RRC and LRC. The methodological quality of the selected studies was assessed. Depending on statistical heterogeneity, the fixed effects model or the random effects model were used for the meta-analysis. Operative time, estimated blood loss, length of hospital stay, conversion rates to open surgery, postoperative complications, and related outcomes were evaluated.ResultsSeven studies, including 234 RRC cases and 415 conventional LRC cases, were analyzed. The meta-analysis showed that RRC had longer operative times (P < 0.00001), lower estimated blood losses (P = 0.0002), lower postoperative overall complications (P = 0.02), and significantly faster bowel function recovery (P < 0.00001). There were no differences in the length of hospital stay (P = 0.12), conversion rates to open surgery (P = 0.48), postoperative ileus (P = 0.08), anastomosis leakage (P = 0.28), and bleeding (P = 0.95).ConclusionsCompared to LRC, RRC was associated with reduced estimated blood losses, reduced postoperative complications, longer operative times, and a significantly faster recovery of bowel function. Other perioperative outcomes were equivalent.

The Surgical Robot: Applications and Advantages in General Surgery

“…More published results from well-done meta-analyses support the superiority of robotic surgery in colorectal resections for oncologic purposes, with the same conclusions already mentioned in terms of blood loss, safety, the length of stay, the return of bowel function, lower estimated blood loss, and conversion rates [16,17]. On the other hand, the efficiency of the robotic platform can be seen when an oncologic resection is performed, as the number of lymph nodes is comparable to that obtained with laparoscopy by the most experienced surgeons [18] Returning to the issue of cost, robotic segmental colon resections have been associated with increased operative time, perhaps due to the surgeons' learning curve, in addition to overuse of non-essential instrumentation [19].…”

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

“…19 Of the 24 studies included in the meta-analysis by Zhang et al, 17 were retrospective, and only the two by Jiménez-Rodríguez et al and Park et al were randomized trials. [20][21][22] All seven articles in the 2014 publication by Xu et al were included in a 2015 publication by Chang et al, and some of these articles also contributed to half of the meta-analysis by Zarak et al 11,12,[22][23][24][25][26] Between 2014 and 2016, three different journals separately published meta-analyses on robotic versus laparoscopic rectal cancer surgery -all included the same eight studies and 1229 patients. [27][28][29] Two of these publications were authored by the same group.…”

Robotic approach to colon resection

“…2 However, the majority of current data for both segmental colectomy and proctectomy are small case series and retrospective in nature limiting their ability to draw concrete conclusions. That being said, the theoretical advantages of utilizing roboticassisted surgery within the confined space of the bony pelvis, such as with a low anterior resection, are widely accepted.…”

“…4,5 Current literature suggests at least equivocal short-term oncologic outcomes such as minimal tumor manipulation, high vascular ligation, and mesenteric lymphadenectomy when performing right and left colectomy. 2 The question remains whether the technical advantages of robotic surgery will translate not only into improved longterm oncologic outcomes but press forward the adaption of minimally invasive techniques for oncologic colon resections.…”

“…Despite these advantages there is a relative paucity of literature supporting the positive impacts on patient outcome of robotic colon resection compared to conventional laparoscopy, and the technology remains saddled with several notable limitations including cost, setup time, and a new technical learning curve. 2 In this review, we will provide an update on the current state of literature regarding robotic colon resection, provide tips on how to effectively prepare and position the patient, and plan port placement. Lastly, we will address the operative approach and pitfalls encountered for right and sigmoid colectomy.…”