MRC Centre for Transplantation, King's College London, King's Health Partners, Department of Urology, Guy's Hospital, UK.
BJU Int. 2012 Nov;110(10):1544-56. doi: 10.1111/j.1464-410X.2012.11015.x. Epub 2012 Mar 22.
Although robotic technology is becoming increasingly popular for urological procedures, barriers to its widespread dissemination include cost and the lack of long term outcomes. This systematic review analyzed studies comparing the use of robotic with laparoscopic and open urological surgery. These three procedures were assessed for cost efficiency in the form of direct as well as indirect costs that could arise from length of surgery, hospital stay, complications, learning curve and postoperative outcomes.
A systematic review was performed searching Medline, Embase and Web of Science databases. Two reviewers identified abstracts using online databases and independently reviewed full length papers suitable for inclusion in the study.
Laparoscopic and robot assisted radical prostatectomy are superior with respect to reduced hospital stay (range 1-1.76 days and 1-5.5 days, respectively) and blood loss (range 482-780 mL and 227-234 mL, respectively) when compared with the open approach (range 2-8 days and 1015 mL). Robot assisted radical prostatectomy remains more expensive (total cost ranging from US $2000-$39,215) than both laparoscopic (range US $740-$29,771) and open radical prostatectomy (range US $1870-$31,518). This difference is due to the cost of robot purchase, maintenance and instruments. The reduced length of stay in hospital (range 1-1.5 days) and length of surgery (range 102-360 min) are unable to compensate for the excess costs. Robotic surgery may require a smaller learning curve (20-40 cases) although the evidence is inconclusive.
Robotic surgery provides similar postoperative outcomes to laparoscopic surgery but a reduced learning curve. Although costs are currently high, increased competition from manufacturers and wider dissemination of the technology could drive down costs. Further trials are needed to evaluate long term outcomes in order to evaluate fully the value of all three procedures in urological surgery.
尽管机器人技术在泌尿科手术中越来越受欢迎，但由于成本问题以及缺乏长期结果，其广泛传播仍存在障碍。本系统评价分析了比较机器人辅助与腹腔镜和开放式泌尿科手术的研究。这三种手术从手术时间、住院时间、并发症、学习曲线和术后结果等方面评估了直接和间接成本的效率。
系统检索了 Medline、Embase 和 Web of Science 数据库。两位审查员使用在线数据库识别摘要，并独立审查了适合纳入研究的全文文章。
与开放式手术相比，腹腔镜和机器人辅助根治性前列腺切除术在住院时间（分别为 1-1.76 天和 1-5.5 天）和出血量（分别为 482-780 mL 和 227-234 mL）方面具有优势。机器人辅助根治性前列腺切除术仍然比腹腔镜（范围为 US $740-US $29,771）和开放式根治性前列腺切除术（范围为 US $1870-US $31,518）更昂贵（总费用范围为 US $2000-US $39,215）。这种差异是由于机器人购买、维护和仪器的成本造成的。住院时间（范围为 1-1.5 天）和手术时间（范围为 102-360 分钟）的缩短不足以弥补额外的成本。机器人手术可能需要较短的学习曲线（20-40 例），尽管证据尚无定论。
机器人手术提供了与腹腔镜手术相似的术后结果，但学习曲线较短。尽管目前成本较高，但制造商之间的竞争加剧和该技术的广泛传播可能会降低成本。需要进一步的试验来评估长期结果，以便充分评估这三种手术在泌尿科手术中的价值。
