Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA; Department of Obstetrics and Gynecology, Women Health Hospital, Assiut University, Egypt.
Division of Preventive Medicine, Mayo Clinic, Rochester, MN, USA.
Gynecol Oncol. 2015 Aug;138(2):457-71. doi: 10.1016/j.ygyno.2015.06.009. Epub 2015 Jun 6.
To compare intraoperative and short-term postoperative outcomes of robotic radical hysterectomy (RRH) to laparoscopic and open approaches in the treatment of early stage cervical cancer.
A search of MEDLINE, EMBASE (using Ovid interface) and SCOPUS databases was conducted from database inception through February 15, 2014. We included studies comparing surgical approaches to radical hysterectomy (robotic vs. laparoscopic or abdominal, or both) in women with stages IA1-IIA cervical cancer. Intraoperative outcomes included estimated blood loss (EBL), operative time, number of pelvic lymph nodes harvested and intraoperative complications. Postoperative outcomes were hospital stay and surgical morbidity. The random effects model was used to pool weighted mean differences (WMDs) and odds ratios (OR).
Twenty six nonrandomized studies were included (10 RRH vs abdominal radical hysterectomy [ARH], 9 RRH vs laparoscopic radical hysterectomy [LRH] and 7 compared all 3 approaches) enrolling 4013 women (1013 RRH, 710 LRH and 2290 ARH). RRH was associated with less EBL (WMD=384.3, 95% CI=233.7, 534.8) and shorter hospital stay (WMD=3.55, 95% CI=2.10, 5.00) than ARH. RRH was also associated with lower odds of febrile morbidity (OR=0.43, 95% CI=0.20-0.89), blood transfusion (OR=0.12, 95% CI 0.06, 0.25) and wound-related complications (OR=0.31, 95% CI=0.13, 0.73) vs. ARH. RRH was comparable to LRH in all intra- and postoperative outcomes.
Current evidence suggests that RRH may be superior to ARH with lower EBL, shorter hospital stay, less febrile morbidity and wound-related complications. RRH and LRH appear equivalent in intraoperative and short-term postoperative outcomes and thus the choice of approach can be tailored to the choice of patient and surgeon.
比较机器人根治性子宫切除术（RRH）与腹腔镜和开腹手术治疗早期宫颈癌的术中及短期术后结果。
对 MEDLINE、EMBASE（使用 Ovid 界面）和 SCOPUS 数据库进行了检索，检索时间从数据库建立至 2014 年 2 月 15 日。我们纳入了比较机器人与腹腔镜或开腹根治性子宫切除术（RRH 与腹腔镜或开腹，或两者）治疗 IA1-IIA 期宫颈癌的手术方法的研究。术中结果包括估计失血量（EBL）、手术时间、盆腔淋巴结清扫数目和术中并发症。术后结果包括住院时间和手术并发症。使用随机效应模型对加权均数差值（WMD）和比值比（OR）进行汇总。
纳入了 26 项非随机研究（10 项 RRH 与腹式根治性子宫切除术[ARH]，9 项 RRH 与腹腔镜根治性子宫切除术[LRH]，7 项比较了所有 3 种方法），共纳入了 4013 名女性（1013 例 RRH，710 例 LRH 和 2290 例 ARH）。RRH 与 ARH 相比，EBL 更少（WMD=384.3，95%CI=233.7，534.8），住院时间更短（WMD=3.55，95%CI=2.10，5.00）。RRH 还与发热性发病率（OR=0.43，95%CI=0.20-0.89）、输血（OR=0.12，95%CI 0.06，0.25）和伤口相关并发症（OR=0.31，95%CI=0.13，0.73）的发生率降低相关。RRH 与 LRH 在所有术中及术后结果方面均相似。
目前的证据表明，RRH 可能优于 ARH，RRH 具有更低的 EBL、更短的住院时间、更低的发热发病率和伤口相关并发症。RRH 和 LRH 在术中及短期术后结果方面相当，因此可以根据患者和外科医生的选择来选择手术方法。
