Kostakis Ioannis D, Sran Harkiran, Uwechue Raphael, Chandak Pankaj, Olsburgh Jonathon, Mamode Nizam, Loukopoulos Ioannis, Kessaris Nicos
Department of Nephrology and Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Robot Surg. 2019 Dec 23;6:27-40. doi: 10.2147/RSRR.S186768. eCollection 2019.
Robotic surgery has been increasingly used in fashioning various surgical anastomoses. Our aim was to collect and analyze outcomes related to anastomoses performed using a robotic approach and compare them with those done using laparoscopic or open approaches through meta-analysis.
A systematic review was conducted for articles comparing robotic with laparoscopic and/or open operations (colectomy, low anterior resection, gastrectomy, Roux-en-Y gastric bypass (RYGB), pancreaticoduodenectomy, radical cystectomy, pyeloplasty, radical prostatectomy, renal transplant) published up to June 2019 searching Medline, Scopus, Google Scholar, Clinical Trials and the Cochrane Central Register of Controlled Trials. Studies containing information about outcomes related to hand-sewn anastomoses were included for meta-analysis. Studies with stapled anastomoses or without relevant information about the anastomotic technique were excluded. We also excluded studies in which the anastomoses were performed extracorporeally in laparoscopic or robotic operations.
We included 83 studies referring to the aforementioned operations (4 randomized controlled and 79 non-randomized, 10 prospective and 69 retrospective) apart from colectomy and low anterior resection. Anastomoses done using robotic instruments provided similar results to those done using laparoscopic or open approach in regards to anastomotic leak or stricture. However, there were lower rates of stenosis in robotic than in laparoscopic RYGB (p=0.01) and in robotic than in open radical prostatectomy (p<0.00001). Moreover, all anastomoses needed more time to be performed using the robotic rather than the open approach in renal transplant (p≤0.001).
Robotic anastomoses provide equal outcomes with laparoscopic and open ones in most operations, with a few notable exceptions.
机器人手术在构建各种外科吻合术中的应用日益广泛。我们的目的是收集并分析与机器人手术方式进行的吻合术相关的结果，并通过荟萃分析将其与腹腔镜或开放手术方式的结果进行比较。
对截至2019年6月发表的比较机器人手术与腹腔镜和/或开放手术（结肠切除术、低位前切除术、胃切除术、Roux-en-Y胃旁路术（RYGB）、胰十二指肠切除术、根治性膀胱切除术、肾盂成形术、根治性前列腺切除术、肾移植）的文章进行系统综述，检索了Medline、Scopus、谷歌学术、临床试验和Cochrane对照试验中央注册库。纳入包含手工缝合吻合术相关结果信息的研究进行荟萃分析。排除使用吻合器吻合术或无吻合技术相关信息的研究。我们还排除了在腹腔镜或机器人手术中在体外进行吻合术的研究。
除结肠切除术和低位前切除术外，我们纳入了83项涉及上述手术的研究（4项随机对照研究和79项非随机研究，10项前瞻性研究和69项回顾性研究）。在吻合口漏或狭窄方面，使用机器人器械进行的吻合术与使用腹腔镜或开放手术方式的结果相似。然而，机器人辅助的RYGB手术的狭窄发生率低于腹腔镜手术（p=0.01），机器人辅助的根治性前列腺切除术的狭窄发生率低于开放手术（p<0.00001）。此外，在肾移植中，所有吻合术使用机器人手术方式比开放手术方式需要更多时间（p≤0.001）。
机器人吻合术在大多数手术中与腹腔镜和开放手术的效果相当，但有一些明显的例外。
