Department of Surgery, Shanghai Tenth People's Hospital Affiliated to Tongji University, Shanghai, People's Republic of China.
Ann Surg Oncol. 2012 Nov;19(12):3727-36. doi: 10.1245/s10434-012-2429-9. Epub 2012 Jul 3.
Robotic colorectal surgery may solve some of the problems inherent to conventional laparoscopic surgery (CLS). We sought to evaluate the advantages of robot-assisted laparoscopic surgery (RALS) using the da Vinci Surgical System over CLS in patients with benign and malignant colorectal diseases.
PubMed and Embase databases were searched for relevant studies published before July 2011. Studies clearly documenting a comparison of RALS with CLS for benign and malignant colorectal diseases were selected. Operative and postoperative measures, resection margins, complications, and related outcomes were evaluated. Weighted mean differences, relative risks, and hazard ratios were calculated using a random-effects model.
The meta-analysis included 16 studies comparing RALS and CLS in patients with colorectal diseases and 7 studies in rectal cancer. RALS was associated with lower estimated blood loss in colorectal diseases (P = 0.04) and rectal cancer (P < 0.001) and lower rates of intraoperative conversion in colorectal diseases (P = 0.03) and rectal cancer (P < 0.001) than CLS. In patients with colorectal diseases, however, operating time (P < 0.001) and total hospitalization cost (P = 0.06) were higher for RALS than for CLS.
RALS was associated with reduced estimated blood loss and a lower intraoperative conversion rate than CLS, with no differences in complication rates and surrogate markers of successful surgery. Robotic colorectal surgery is a promising tool, especially for patients with rectal cancer.
机器人结直肠手术可能解决一些传统腹腔镜手术（CLS）固有的问题。我们试图评估达芬奇机器人手术系统辅助腹腔镜手术（RALS）相对于 CLS 在治疗结直肠良恶性疾病方面的优势。
检索 2011 年 7 月前发表的有关 RALS 与 CLS 比较的研究，纳入明确比较 RALS 与 CLS 治疗结直肠良恶性疾病的研究。评估手术和术后措施、切缘、并发症和相关结局。采用随机效应模型计算加权均数差、相对风险和危险比。
荟萃分析纳入了 16 项 RALS 与 CLS 治疗结直肠疾病的比较研究和 7 项直肠癌研究。与 CLS 相比，RALS 治疗结直肠疾病（P=0.04）和直肠癌（P<0.001）术中出血量更少，且术中中转开腹率更低（P=0.03 和 P<0.001）。但在结直肠疾病患者中，RALS 的手术时间（P<0.001）和总住院费用（P=0.06）更高。
与 CLS 相比，RALS 可减少估计失血量和降低术中中转开腹率，且并发症发生率和手术成功的替代标志物无差异。机器人结直肠手术是一种有前途的工具，特别是对于直肠癌患者。
