Division of General Surgery, Department of Surgery University of Toronto, Toronto, Canada.
Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada.
Ann Surg. 2021 Mar 1;273(3):467-473. doi: 10.1097/SLA.0000000000003915.
Describe clinical outcomes (eg, postoperative complications, survival) after robotic surgery compared to open or laparoscopic surgery.
Robotic surgery utilization has increased over the years across a wide range of surgical procedures. However, evidence supporting improved clinical outcomes after robotic surgery is limited.
We systematically searched MEDLINE, EMBASE, and the Cochrane Central Register of systematic reviews from inception to January 2019 for systematic reviews describing postoperative outcomes after robotic surgery. We qualitatively described patient outcomes of commonly performed robotic procedures: radical prostatectomy, hysterectomy, lobectomy, thymectomy, rectal resection, partial nephrectomy, distal gastrectomy, Roux-en-Y gastric bypass, hepatectomy, distal pancreatectomy, and cholecystectomy.
One hundred fifty-four systematic reviews included 336 studies and 18 randomized controlled trials reporting on patient outcomes after robotic compared to laparoscopic or open procedures. Data from the randomized controlled trials demonstrate that robotic-assisted radical prostatectomy offered fewer biochemical recurrence and improvement in quality of recovery and pain scores only up to 6 weeks postoperatively compared to open radical prostatectomy. When compared to laparoscopic prostatectomy, robotic surgery offered improved urinary and sexual functions. Robotic surgery for endometrial cancer had fewer conversion to open compared to laparoscopic. Otherwise, robotic surgery outcomes were similar to conventional surgical approaches for other procedures except for radical hysterectomy where minimally invasive approaches may result in patient harm compared to open approach.
Robotic surgery has been widely incorporated into practise despite limited supporting evidence. More rigorous research focused on patient-important benefits is needed before further expansion of robotic surgery.
描述机器人手术与开放或腹腔镜手术相比的临床结果（例如术后并发症、生存率）。
机器人手术在多年来在广泛的手术中得到了越来越多的应用。然而，支持机器人手术后临床结果改善的证据有限。
我们系统地检索了 MEDLINE、EMBASE 和 Cochrane 系统评价中心数据库，从建库到 2019 年 1 月，以获取描述机器人手术后术后结果的系统评价。我们定性描述了常见机器人手术的患者结果：根治性前列腺切除术、子宫切除术、肺叶切除术、胸腺切除术、直肠切除术、部分肾切除术、远端胃切除术、Roux-en-Y 胃旁路术、肝切除术、远端胰腺切除术和胆囊切除术。
154 篇系统评价纳入了 336 项研究和 18 项随机对照试验，报告了机器人与腹腔镜或开放手术相比的患者结果。随机对照试验的数据表明，与开放根治性前列腺切除术相比，机器人辅助根治性前列腺切除术在术后 6 周内具有较低的生化复发率和恢复质量以及疼痛评分的改善。与腹腔镜前列腺切除术相比，机器人手术提供了更好的尿控和性功能。机器人手术治疗子宫内膜癌与腹腔镜相比，转为开放手术的比例更低。否则，机器人手术的结果与其他手术的传统手术方法相似，除了根治性子宫切除术，微创方法可能会对患者造成伤害，而开放手术则不会。
尽管缺乏支持证据，但机器人手术已经广泛应用于实践中。在进一步扩大机器人手术之前，需要更关注患者重要获益的更严格的研究。
