Health Technology Assessment Unit, Laín Entralgo Agency, C/Gran Vía 27, 7°, Madrid 28013, Spain.
Br J Surg. 2010 Dec;97(12):1772-83. doi: 10.1002/bjs.7269.
The safety and effectiveness of robotic, open and conventional laparoscopic surgery in gynaecological surgery was assessed in a systematic review of the literature. This will enable the general surgical community to understand where robotic surgery stands in gynaecology.
A search was made for previous systematic reviews in the Abstracts of Reviews of Effects, Health Technology Assessment, Cochrane Collaboration and Hayes Inc. databases. In addition, the MEDLINE, Embase and CINAHL databases were searched for primary studies. The quality of studies was assessed and meta-analyses were performed.
Twenty-two studies were included in the review. All were controlled but none was randomized. The majority were retrospective with historical controls. The settings in which robotic surgery was used included hysterectomy for malignant and benign disease, myomectomy, sacrocolpopexy, fallopian tube reanastomosis and adnexectomy. Robotic surgery achieved a shorter hospital stay and less blood loss than open surgery. Compared with conventional laparoscopic surgery, robotic surgery achieved reduced blood loss and fewer conversions during the staging of endometrial cancer. No clinically significant differences were recorded for the other indications tested.
The available evidence shows that robotic surgery offers limited advantages with respect to short-term outcomes. However, the clinical outcomes should be interpreted with caution owing to the methodological quality of the studies.
本系统综述对机器人手术、开放手术和传统腹腔镜手术在妇科手术中的安全性和有效性进行了评估，旨在使普通外科医生了解机器人手术在妇科领域的地位。
在效应摘要、卫生技术评估、考科蓝协作和海斯公司数据库中对以往的系统综述进行了检索。此外，还在 MEDLINE、Embase 和 CINAHL 数据库中对原始研究进行了检索。评估了研究的质量并进行了荟萃分析。
综述纳入了 22 项研究。所有研究均为对照研究，但均未进行随机分组。大多数为回顾性研究，且存在历史对照。机器人手术的应用范围包括恶性和良性疾病的子宫切除术、子宫肌瘤切除术、骶骨阴道固定术、输卵管再吻合术和附件切除术。与开放手术相比，机器人手术的住院时间更短，出血量更少。与传统腹腔镜手术相比，机器人手术在子宫内膜癌分期时出血量更少，中转开腹率更低。但其他适应证的结果并无显著差异。
现有证据表明，机器人手术在短期结局方面具有一定优势。但由于研究方法学质量欠佳，临床结局的解读应谨慎。
