Division of Urology, Taipei Tzu Chi Hospital, Tzu Chi Medical Foundation, New Taipei City, 231, Taiwan.
School of Medicine, Tzu Chi University, Hualien, 970, Taiwan.
Int Urogynecol J. 2022 Feb;33(2):297-308. doi: 10.1007/s00192-021-04741-x. Epub 2021 Mar 24.
Abdominal sacrocolpopexy is regarded as the gold standard for management of pelvic organ prolapse (POP). Nowadays, minimally invasive surgeries are preferred, and sacrocolpopexy can be performed using either a laparoscopic or robotic-assisted approach. The aim of the current study was to compare the efficacy and safety of robotic-assisted sacrocolpopexy (RASC) and laparoscopic sacrocolpopexy (LSC) through an updated systematic review and meta-analysis.
We performed a systematic literature review of different databases and related references from their inception until July 2020 without language restrictions. All randomized control trials and comparative studies that compared RASC and LSC for the management of POP were included.
A total of 13 studies including 2115 participants were included for the pooled analysis. The pooled results revealed that RASC was associated with a significantly longer operative time (weighted mean difference, 29.53 min; 95% confidence interval [CI], 12.88 to 46.18 min, P = 0.0005), significantly less estimated blood loss (weighted mean difference, -86.52 ml; 95% CI -130.26 to -42.79 ml, P = 0.0001), significantly fewer overall intraoperative complications (odds ratio [OR] 0.6; 95% CI 0.40 to 0.91; P = 0.01) and significantly lower conversion rate (OR 0.39; 95% CI 0.19 to 0.82; P = 0.01) compared with LSC. There were no significant differences between the length of hospital stays, overall postoperative complications, postoperative stress incontinence, mesh erosion and effectiveness between the two groups.
The current study showed comparable efficacy between RASC and LSC. Though RASC was associated with less blood loss and a lower conversion rate, the differences were not clinically significant. The choice of surgical procedure with either RASC or LSC is according to surgeon discretion and patient preferences.
腹式骶骨阴道固定术被认为是治疗盆腔器官脱垂（POP）的金标准。如今，微创手术更受欢迎，骶骨阴道固定术可以通过腹腔镜或机器人辅助手术来完成。本研究的目的是通过更新的系统评价和荟萃分析比较机器人辅助骶骨阴道固定术（RASC）和腹腔镜骶骨阴道固定术（LSC）的疗效和安全性。
我们对不同数据库进行了系统的文献回顾，并从其开始到 2020 年 7 月对相关参考文献进行了无语言限制的回顾。所有比较 RASC 和 LSC 治疗 POP 的随机对照试验和对照研究均包括在内。
共有 13 项研究，包括 2115 名参与者被纳入荟萃分析。汇总结果显示，RASC 手术时间明显延长（加权均数差，29.53 分钟；95%置信区间[CI]，12.88 至 46.18 分钟，P=0.0005），术中估计出血量明显减少（加权均数差，-86.52 毫升；95%CI-130.26 至-42.79 毫升，P=0.0001），总术中并发症明显减少（比值比[OR]0.6；95%CI0.40 至 0.91；P=0.01），转换率明显降低（OR0.39；95%CI0.19 至 0.82；P=0.01），与 LSC 相比。两组的住院时间、总术后并发症、术后压力性尿失禁、网片侵蚀和疗效无显著差异。
本研究显示 RASC 和 LSC 之间疗效相当。尽管 RASC 术中出血量较少，转换率较低，但差异无临床意义。手术方式的选择，无论是 RASC 还是 LSC，都取决于外科医生的判断和患者的偏好。
