Guadagni Simone, Palmeri Matteo, Bianchini Matteo, Gianardi Desirée, Furbetta Niccolò, Minichilli Fabrizio, Di Franco Gregorio, Comandatore Annalisa, Di Candio Giulio, Morelli Luca
General Surgery Unit, Department of Translational Research and new Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
Unit of Environmental Epidemiology and Disease Registries, Institute of Clinical Physiology, National Council of Research, Pisa, Italy.
Int J Colorectal Dis. 2021 Jun;36(6):1097-1110. doi: 10.1007/s00384-021-03850-9. Epub 2021 Jan 23.
Robotic assistance could increase the rate of ileo-colic intra-corporeal anastomosis (ICA) during robotic right colectomy (RRC). However, although robotic ICA can be accomplished with several different technical variants, it is not clear whether some of these technical details should be preferred. An evaluation of the possible advantage of one respect to another would be useful.
We conducted a systematic review of literature on technical details of robotic ileo-colic ICA, from which we performed a meta-analysis of clinical outcomes. The extracted data allowed a comparative analysis regarding the outcome of overall complication (OC), bleeding rate (BR) and leakage rate (LR), between (1) mechanical anastomosis with robotic stapler, versus laparoscopic stapler, versus totally hand-sewn anastomosis and (2) closure of enterocolotomy with manual double layer, versus single layer, versus stapled.
A total of 30 studies including 2066 patients were selected. Globally, the side-to-side, isoperistaltic anastomosis, realized with laparoscopic staplers, and double-layer closure for enterocolotomy, is the most common technique used. According to the meta-analysis, the use of robotic stapler was significantly associated with a reduction of the BR with respect to mechanical anastomosis with laparoscopic stapler or totally hand-sewn anastomosis. None of the other technical aspects significantly influenced the outcomes.
ICA fashioning during RRC can be accomplished with several technical variants without evidence of a clear superiority of anyone of these techniques. Although the use of robotic staplers could be associated with some benefits, further studies are necessary to draw conclusions.
机器人辅助可提高机器人右半结肠切除术（RRC）期间回结肠体内吻合术（ICA）的成功率。然而，尽管机器人ICA可以通过几种不同的技术变体来完成，但尚不清楚这些技术细节中是否有一些更值得推荐。评估一种技术相对于另一种技术的潜在优势将是有益的。
我们对关于机器人回结肠ICA技术细节的文献进行了系统综述，并对临床结果进行了荟萃分析。提取的数据允许对以下方面的结果进行比较分析：（1）使用机器人吻合器进行机械吻合、腹腔镜吻合器吻合与完全手工缝合吻合之间的总体并发症（OC）、出血率（BR）和渗漏率（LR）；（2）手工双层缝合、单层缝合与吻合器缝合关闭肠切开术之间的情况。
共纳入30项研究，涉及2066例患者。总体而言，使用腹腔镜吻合器进行的侧侧、顺蠕动吻合以及双层缝合关闭肠切开术是最常用的技术。根据荟萃分析，与使用腹腔镜吻合器进行机械吻合或完全手工缝合吻合相比，使用机器人吻合器与出血率降低显著相关。其他技术方面均未对结果产生显著影响。
RRC期间的ICA构建可以通过几种技术变体来完成，没有证据表明这些技术中有任何一种具有明显优势。尽管使用机器人吻合器可能有一些益处，但仍需要进一步研究才能得出结论。
