Chinese PLA Medical Academy, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China; Department of Neurosurgery, PLA General Hospital, Beijing, China.
Department of Neurosurgery, PLA General Hospital, Beijing, China.
J Clin Neurosci. 2020 Dec;82(Pt B):252-259. doi: 10.1016/j.jocn.2020.10.045. Epub 2020 Nov 26.
The aim of this review is to determine the efficacy and safety of robotic surgery for intracranial hemorrhage (ICH). PICO question was formulated as: whether robot-assisted neurosurgery is more effective and safer than conventional treatment for ICH with respect to drainage time, complications, operation time, extent of evacuation and neurological function improvement. We searched PubMed, Web of Science, Wiley Online, OVID, Embase, Cochrane Library, Clinical Trails, Current Controlled Trials, Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure (CNKI), OpenGrey and references of related papers. Key words included robot, robotic, hematoma, hemorrhage and neurosurgery. Then we used Microsoft Excel to collect data. Except from qualitative analysis, we did meta-analysis using Review Manager 5.3. 9 papers were included in qualitative synthesis, 6 in meta-analysis for rebleeding rate and 4 in analysis for operative and drainage time. Qualitative synthesis showed shorter operative time and drainage time, a larger extent of evacuation, better neurological function improvement and less complications in robotic group, while meta-analysis suggested that robot-assisted surgery reduced rebleeding rate compared to other surgical procedures, but whether it is superior to conservative treatment in preventing rebleeding still needs more proof. Meta-analysis for operative and drainage time should be explained cautiously because a significant heterogeneity existed and we supposed that differences in baseline characteristics might influence the results. Finally, we drew a conclusion that robotic neurosurgery is a safe and effective approach which is better than conventional surgery or conservative treatment with respect to rebleeding rate, intracranial infection rate and neurological function improvement.
本次综述的目的在于确定机器人手术治疗颅内出血（ICH）的疗效和安全性。我们制定了 PICO 问题，即与常规治疗相比，机器人辅助神经外科手术在引流时间、并发症、手术时间、清除程度和神经功能改善方面，对于 ICH 是否更有效和更安全。我们在 PubMed、Web of Science、Wiley Online、OVID、Embase、Cochrane 图书馆、临床实验、当前对照实验、中国生物医学文献数据库（CBM）、中国知网（CNKI）、OpenGrey 和相关文献的参考文献中进行了检索。关键词包括机器人、机器人、血肿、出血和神经外科。然后，我们使用 Microsoft Excel 收集数据。除定性分析外，我们还使用 Review Manager 5.3 进行了荟萃分析。9 篇论文用于定性综合分析，6 篇用于再出血率的荟萃分析，4 篇用于手术和引流时间的分析。定性综合分析显示机器人组手术时间和引流时间更短、清除程度更大、神经功能改善更好、并发症更少，而荟萃分析表明与其他手术程序相比，机器人辅助手术可降低再出血率，但在预防再出血方面是否优于保守治疗仍需更多证据。手术和引流时间的荟萃分析应谨慎解释，因为存在显著的异质性，我们假设基线特征的差异可能会影响结果。最后，我们得出结论，机器人神经外科是一种安全有效的方法，在再出血率、颅内感染率和神经功能改善方面优于传统手术或保守治疗。
