Nota Carolijn L, Rinkes Inne H Borel, Molenaar Izaak Q, van Santvoort Hjalmar C, Fong Yuman, Hagendoorn Jeroen
Department of Surgery, University Medical Center Utrecht, The Netherlands.
Department of Surgery, University Medical Center Utrecht, The Netherlands; Department of Surgery, St. Antonius Ziekenhuis Nieuwegein, The Netherlands.
HPB (Oxford). 2016 Feb;18(2):113-120. doi: 10.1016/j.hpb.2015.09.003. Epub 2015 Dec 11.
Robotic surgery has been introduced to overcome the limitations of conventional laparoscopy. A systematic review and meta-analysis were performed to assess the safety and feasibility for three subgroups of robot-assisted laparoscopic liver resection: (i) minor resections of easily accessible segments: 2/3, 4B, 5, 6, (ii) minor resections of difficult located segments: 1, 4A, 7, 8 and (iii) major resections: ≥ 4 segments.
A systematic search was performed in PubMed, EMBASE and Cochrane Library.
Twelve observational, mostly retrospective studies reporting on 363 patients were included. Data were pooled and analyzed. For subgroup (i) (n = 81) the weighted mean operative time was 215 ± 65 min. One conversion (1%) to laparotomy was needed. Weighted mean operative time for subgroup (ii) (n = 17) was 220 ± 60 min. No conversions were needed. For subgroup (iii) (n = 99) the weighted mean operative time was 405 ± 100 min. In this subgroup 8 robotic procedures (8%) were converted to open surgery.
Data show that robot-assisted laparoscopic liver resection is feasible in minor resections of all segments and major resections. Larger, prospective studies are warranted to compare the possible advantages of robot-assisted surgery with conventional laparoscopy and open surgery.
机器人手术已被引入以克服传统腹腔镜手术的局限性。进行了一项系统评价和荟萃分析，以评估机器人辅助腹腔镜肝切除术三个亚组的安全性和可行性：（i）易于接近的肝段的小范围切除术：第2/3、4B、5、6段；（ii）位置较难的肝段的小范围切除术：第1、4A、7、8段；（iii）大范围切除术：≥4个肝段。
在PubMed、EMBASE和Cochrane图书馆进行了系统检索。
纳入了12项观察性研究，大多为回顾性研究，共报告了363例患者。对数据进行汇总和分析。对于亚组（i）（n = 81），加权平均手术时间为215±65分钟。需要1例（1%）转为开腹手术。亚组（ii）（n = 17）的加权平均手术时间为220±60分钟。无需转为开腹手术。对于亚组（iii）（n = 99），加权平均手术时间为405±100分钟。在该亚组中，8例机器人手术（8%）转为开放手术。
数据表明，机器人辅助腹腔镜肝切除术在所有肝段的小范围切除术和大范围切除术中都是可行的。需要开展更大规模的前瞻性研究，以比较机器人辅助手术与传统腹腔镜手术和开放手术相比可能存在的优势。
