Ciria Ruben, Berardi Giammauro, Alconchel Felipe, Briceño Javier, Choi Gi Hong, Wu Yao-Ming, Sugioka Atsushi, Troisi Roberto Ivan, Salloum Chady, Soubrane Olivier, Pratschke Johann, Martinie John, Tsung Allan, Araujo Raphael, Sucandy Iswanto, Tang Chung N, Wakabayashi Go
Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, Córdoba, Spain.
Center for Advanced Treatment of HBP Diseases, Ageo Central General Hospital, Saitama, Japan.
J Hepatobiliary Pancreat Sci. 2022 Feb;29(2):181-197. doi: 10.1002/jhbp.869. Epub 2020 Dec 13.
The dissemination of robotic liver surgery is slow-paced and must face the obstacle of demonstrating advantages over open and laparoscopic (LLS) approaches. Our objective was to show the current position of robotic liver surgery (RLS) worldwide and to identify if improved short-term outcomes are observed, including secondary meta-analyses for type of resection, etiology, and cost analysis.
A PRISMA-based systematic review was performed to identify manuscripts comparing RLS vs open or LLS approaches. Quality analysis was performed using the Newcatle-Ottawa score. Statistical analysis was performed after heterogeneity test and fixed- or random-effect models were chosen accordingly.
After removing duplications, 2728 RLS cases were identified from the final set of 150 manuscripts. More than 75% of the cases have been performed on malignancies. Meta-analysis from the 38 comparative reports showed that RLS may offer improved short-term outcomes compared to open procedures in most of the variables screened. Compared to LLS, some advantages may be observed in favour of RLS for major resections in terms of operative time, hospital stay and rate of complications. Cost analyses showed an increased cost per procedure of around US$5000.
The advantages of RLS still need to be demonstrated although early results are promising. Advantages vs open approach are demonstrated. Compared to laparoscopic surgery, minor perioperative advantages may be observed for major resections although cost analyses are still unfavorable to the robotic approach.
机器人肝脏手术的推广进展缓慢，必须面对证明其优于开放手术和腹腔镜手术（LLS）的障碍。我们的目标是展示机器人肝脏手术（RLS）在全球的现状，并确定是否观察到短期结果有所改善，包括对切除类型、病因和成本分析的二次荟萃分析。
进行了一项基于PRISMA的系统评价，以确定比较RLS与开放手术或LLS方法的手稿。使用纽卡斯尔-渥太华评分进行质量分析。在进行异质性检验后进行统计分析，并相应选择固定效应模型或随机效应模型。
去除重复项后，从150篇手稿的最终数据集中确定了2728例RLS病例。超过75%的病例是针对恶性肿瘤进行的。38份比较报告的荟萃分析表明，在大多数筛选变量中，与开放手术相比，RLS可能提供更好的短期结果。与LLS相比，在主要肝切除手术的手术时间、住院时间和并发症发生率方面，RLS可能具有一些优势。成本分析显示，每次手术的成本增加了约5000美元。
尽管早期结果令人鼓舞，但RLS的优势仍需得到证明。与开放手术相比，其优势已得到证明。与腹腔镜手术相比，在主要肝切除手术中，围手术期可能有一些小的优势，尽管成本分析对机器人手术方法仍然不利。
