Department of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei, China.
Department of Urology, Institute of Urology, Anhui Medical University, Hefei, China.
J Endourol. 2021 May;35(5):623-632. doi: 10.1089/end.2020.0432. Epub 2020 Nov 12.
To systematically explore the superiority of the transperitoneal approach in robot-assisted partial nephrectomy (TP-RAPN) and retroperitoneal approach in robot-assisted partial nephrectomy (RP-RAPN). Several databases were searched including PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, CBM, Wan Fang, and VIP to identify relevant studies that reported the comparison of the TP-RAPN and RP-RAPN. Outcomes of data were pooled and analyzed with Review Manager 5.3 to compare the intraoperative and postoperative variables and postoperative complications. Based on the heterogeneity of the studies, odds ratios (ORs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated using a random-effect model or fixed-effect model. The sensitivity analysis and the subgroup analysis were used to minimize the effects of heterogeneity. And, publication bias was assessed by funnel plots. In all, 16 studies met the inclusion criteria, including 2336 TP-RAPN patients and 1705 RP-RAPN patients. This meta-analysis reviewed 16 studies on RAPN, and the RP-RAPN showed shorter operative time (OT) (WMD 13.18 minutes; 95% CI 5.04-21.31; = 0.001), shorter postoperative bowel function recovery (WMD 1.97 days; 95% CI 0.43-3.52; = 0.01), shorter length of stay (LOS) (WMD 0.51 days; 95% CI 0.25-0.77; = 0.0001), and lower estimated blood loss (EBL) (WMD 7.08 mL; 95% CI 1.41-12.74; = 0.01) than the TP-RAPN. Additionally, no significant differences were found in other outcomes. In comparison, the RP-RAPN had significantly shorter OT, postoperative bowel function recovery time, LOS, and lower EBL. The RP-RAPN is associated with better value for posterior and laterally located tumors and is faster and equally safe and low costs for the patient.
为了系统地探讨经腹腔途径机器人辅助部分肾切除术（TP-RAPN）与经腹膜后途径机器人辅助部分肾切除术（RP-RAPN）的优势。检索了包括 PubMed、EMBASE、Cochrane 图书馆、Web of Science、中国知网（CNKI）、中国生物医学文献数据库（CBM）、万方数据库和维普数据库在内的多个数据库，以确定报道 TP-RAPN 与 RP-RAPN 比较的相关研究。使用 Review Manager 5.3 汇总和分析数据结果，以比较术中及术后变量和术后并发症。基于研究的异质性，使用随机效应模型或固定效应模型计算比值比（ORs）和加权均数差（WMDs）及其 95%置信区间（CIs）。使用敏感性分析和亚组分析来最小化异质性的影响。并通过漏斗图评估发表偏倚。共纳入 16 项符合纳入标准的研究，其中包括 2336 例 TP-RAPN 患者和 1705 例 RP-RAPN 患者。这项荟萃分析共纳入了 16 项关于 RAPN 的研究，结果显示 RP-RAPN 组的手术时间（OT）更短（WMD 13.18 分钟；95%CI 5.04-21.31； = 0.001），术后肠道功能恢复时间（WMD 1.97 天；95%CI 0.43-3.52； = 0.01）更短，住院时间（LOS）更短（WMD 0.51 天；95%CI 0.25-0.77； = 0.0001），估计失血量（EBL）更少（WMD 7.08 mL；95%CI 1.41-12.74； = 0.01）。此外，其他结局未见明显差异。相比之下，RP-RAPN 组的 OT、术后肠道功能恢复时间、LOS 和 EBL 更短。RP-RAPN 对于后位和外侧位肿瘤具有明显的优势，并且对于患者来说，手术速度更快、同样安全且费用更低。
