El-Taji Omar, Howell-Etienne Jack, Taktak Samih, Hanchanale Vishwanath
Department of Urology, Royal Liverpool and Broadgreen University Hospitals, Prescot St, Liverpool, L7 8XP, UK.
School of Health and Life Sciences, University of Liverpool, Liverpool, UK.
J Robot Surg. 2023 Apr;17(2):303-312. doi: 10.1007/s11701-022-01445-2. Epub 2022 Jul 21.
Robotic-assisted laparoscopic radical prostatectomy (RARP) has been traditionally performed at a pneumoperitoneum insufflation pressure of 12-15 mmHg. This meta-analysis and systematic review aims to assess the current evidence comparing lower to standard pressure pneumoperitoneum in RARP. Systematic searches of MEDLINE, COCHRANE, SCOPUS and EMBASE were performed to identify articles published up until November 2021 comparing lower pressure with standard pressure pneumoperitoneum in RARP. Standard pressure was defined as > 12 mmHg and lower pressure ≤ 12 mmHg. Estimated blood loss, length of operation, length of hospital stay, post-operative ileus, 30-day readmissions, Clavien-Dindo complications and rate of positive surgical margins were extracted as endpoints of interest. Our searches identified 165 abstracts of which 4 articles with 1319 patients were eligible. Cumulative analysis demonstrated reduced length of stay when a lower pressure was used: WMD - 0.23 (- 0.45 to - 0.02) days (p = 0.03) as well as a reduced rate of post-operative ileus: OR 0.41 (0.22 to 0.77) (p = 0.006). There was no significant increase in length of operation WMD - 1.79 (- 15.96 to 12.38) (p = 0.8), estimated blood loss WMD - 2.89 (- 29.41 to 23.62) (p = 0.83), 30-day readmissions or positive surgical margins OR 1.04 (0.78 to 1.38) (p = 0.81) and RD - 0.01 (- 0.04 to 0.01) (p = 0.3) when using a lower pressure. We have demonstrated reduced length of stay and rates of post-operative ileus, when performing RARP at a lower pressure without a significant increase in length of operation, estimated blood loss, positive surgical margins or complications. The recommendation to use lower pressure pneumoperitoneum is moderate to weak and more randomised control trials are required to validate these results.
传统上，机器人辅助腹腔镜根治性前列腺切除术（RARP）是在12 - 15mmHg的气腹压力下进行的。本荟萃分析和系统评价旨在评估目前比较RARP中较低压力与标准压力气腹的证据。对MEDLINE、COCHRANE、SCOPUS和EMBASE进行了系统检索，以识别截至2021年11月发表的比较RARP中较低压力与标准压力气腹的文章。标准压力定义为>12mmHg，较低压力≤12mmHg。提取估计失血量、手术时长、住院时长、术后肠梗阻、30天再入院率、Clavien-Dindo并发症和手术切缘阳性率作为感兴趣的终点指标。我们的检索共识别出165篇摘要，其中4篇文章共纳入1319例患者符合要求。累积分析表明，使用较低压力时住院时长缩短：加权均数差（WMD）为-0.23（-0.45至-0.02）天（p = 0.03），术后肠梗阻发生率也降低：比值比（OR）为0.41（0.22至0.77）（p = 0.006）。使用较低压力时，手术时长（WMD为-1.79（-15.96至12.38），p = 0.8）、估计失血量（WMD为-2.89（-29.41至23.62），p = 0.83）、30天再入院率或手术切缘阳性率（OR为1.04（0.78至1.38），p = 0.81）以及风险差（RD为-0.01（-0.04至0.01），p = 0.3）均无显著增加。我们已经证明，在较低压力下进行RARP时，住院时长和术后肠梗阻发生率降低，而手术时长、估计失血量、手术切缘阳性率或并发症均无显著增加。使用较低压力气腹的建议力度为中等偏弱，需要更多随机对照试验来验证这些结果。
