Liu Hanghang, Wang Yue, Wu Chenzhou, Fei Wei, Luo En
State Key Laboratory of Oral Disease and National Clinical Research Center for Oral Diseases and, Dept. of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No 14, Section 3 of Renmin South Road, Chengdu, 610041, Sichuan, People's Republic of China.
Shanghai Huangpu District Dental Clinic, Shanghai, 200001, People's Republic of China.
J Cancer Res Clin Oncol. 2020 Dec;146(12):3297-3312. doi: 10.1007/s00432-020-03418-0. Epub 2020 Oct 27.
Robotic surgical system has been gradually applied in thyroid neoplasms as a novel treatment for years, with presenting some superiorities as well as limitations. To compare the effectiveness and safety of robotic surgery with open surgery for the patients with thyroid neoplasms, this review was conducted METHODS: We performed electronic search in CENTRAL, MEDLINE, EMBASE, CNKI, CBM, Opengray, and Sciencepaper Online databases and manual search in specific online databases and according to the reference list of relevant papers to get all the studies that compared the effectiveness and safety of robotic surgery with that of open surgery for patients with thyroid neoplasms. Last update was conducted in March 2020. Randomized-controlled trials, case-control studies, cohort studies, and cross-sectional surveys were all included.
In this review, 59 studies were included: two RCTs, 15 NRSs, 40 cohort studies, and two cross-sectional studies. Robotic surgery was found to be associated with longer operative duration, less retrieved lymph nodes, higher postoperative thyroglobulin before radioactive iodine ablation, similar complication incidence but less blood loss, better functional recovery, and higher cosmetic satisfaction compared to open surgery.
Robotic surgery is a safe and feasible approach with remarkable superiority in reducing intraoperative damage and improving patients' quality of life compared to open surgery for thyroid neoplasms. Meanwhile, this procedure is also associated with long operative duration, insufficient removal of neck lymph nodes, which need to be given careful consideration.
多年来，机器人手术系统已逐渐应用于甲状腺肿瘤的治疗，作为一种新型治疗方法，它既有一些优势，也有局限性。为比较机器人手术与开放手术治疗甲状腺肿瘤患者的有效性和安全性，进行了本综述。方法：我们在CENTRAL、MEDLINE、EMBASE、中国知网、中国生物医学文献数据库、Opengray和中国科技论文在线数据库中进行电子检索，并在特定在线数据库中以及根据相关论文的参考文献列表进行手工检索，以获取所有比较机器人手术与开放手术治疗甲状腺肿瘤患者有效性和安全性的研究。最后一次更新于2020年3月进行。纳入随机对照试验、病例对照研究、队列研究和横断面调查。
本综述纳入59项研究：两项随机对照试验、15项非随机对照研究、40项队列研究和两项横断面研究。结果发现，与开放手术相比，机器人手术的手术时间更长，获取的淋巴结更少，放射性碘消融前术后甲状腺球蛋白水平更高，并发症发生率相似但失血量更少，功能恢复更好，美容满意度更高。
与甲状腺肿瘤开放手术相比，机器人手术是一种安全可行的方法，在减少术中损伤和提高患者生活质量方面具有显著优势。同时，该手术还存在手术时间长、颈部淋巴结清扫不充分等问题，需要慎重考虑。
