Xie Siqi, Huang Yanbing, He Yuanbin, Liu Mingkun, Wu Dianming, Fang Yifan
Department of Pediatric Surgery, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Children's Hospital, Fujian Medical University, Fuzhou, China.
Front Pediatr. 2022 Aug 11;10:968960. doi: 10.3389/fped.2022.968960. eCollection 2022.
Choledochal cysts (CC) are rare disorders characterized by congenital biliary dilatation of the intrahepatic or extrahepatic bile ducts and always relate to pancreaticobiliary maljunction. Robot-assisted surgery has been able to complete almost all pediatric endoscopic surgery nowadays. But evidence of the post-operative outcomes of robotic-assisted operation is limited, comparing with the laparoscopic operation and traditional open operation. The aim of this meta-analysis was to identify the advantages and deficiencies about robotic-assisted operation for CC.
A meta-analysis of retrospective studies published in PUBMED, MEDLINE, Web of Science and China National Knowledge Infrastructure (CNKI). No date limit was used, with the last search on April 30, 2022. No publication restrictions or study design filters were applied.
Nine retrospective cohort studies with 1,395 patients [366 in the robotic-assisted operation group (RG), 532 in the laparoscopic operation group (LG) and 497 in the open operation group (OG)] were enrolled in our study. Subgroup analysis demonstrated the RG had significant longer operative time [standardized mean difference (SMD) = 1.59, 95% CI = (0.02, 3.16), < 0.05], less blood loss [SMD = -1.52, 95% CI = (-2.71, -0.32), < 0.05], shorter enteral feeding time [SMD = -0.83, 95% CI = (-1.22, -0.44), < 0.001], shorter time to stay in the hospital [SMD = -0.81, 95% CI = (-1.23, -0.38), < 0.001], fewer post-operative complications [Relative risk (RR) =1.09, 95% CI = (1.04, 1.13), < 0.001] but higher expenses [SMD = 8.58, 95% CI = (5.27, 11.89), < 0.001] than LG. While a significant older age [SMD = 0.46, 95% CI = (0.26, 0.66), < 0.001], longer operative time [SMD = 3.96, 95% CI = (2.38, 5.55), < 0.001] and shorter time to stay in the hospital [SMD = -0.93, 95% CI = (-1.62, -0.25), < 0.05] than OG.
Laparoscopic and robotic-assisted procedure are both safe and minimal invasive operational strategies. Robotic-assisted procedure may slowly surpass and has a trend to replace laparoscopy for its advantages. More experiences in robotic-assisted operation should be accumulated for the unexpected complexities, so as to be more stable in the younger age of children.
胆总管囊肿（CC）是一种罕见的疾病，其特征为肝内或肝外胆管的先天性胆管扩张，且常与胰胆管合流异常有关。如今，机器人辅助手术已能够完成几乎所有的小儿内镜手术。但与腹腔镜手术和传统开放手术相比，机器人辅助手术术后结果的证据有限。本荟萃分析的目的是确定机器人辅助手术治疗CC的优缺点。
对发表在PubMed、MEDLINE、科学网和中国知网（CNKI）上的回顾性研究进行荟萃分析。未设定日期限制，最后一次检索时间为2022年4月30日。未应用发表限制或研究设计筛选条件。
我们的研究纳入了9项回顾性队列研究，共1395例患者[机器人辅助手术组（RG）366例，腹腔镜手术组（LG）532例，开放手术组（OG）497例]。亚组分析显示，与LG相比，RG的手术时间显著更长[标准化均数差（SMD）=1.59，95%可信区间（CI）=（0.02，3.16），P<0.05]，失血量更少[SMD=-1.52，95%CI=（-2.71，-0.32），P<0.05]，肠内喂养时间更短[SMD=-0.83，95%CI=（-1.22，-0.44），P<0.001]，住院时间更短[SMD=-0.81，95%CI=（-1.23，-0.38），P<0.001]，术后并发症更少[相对危险度（RR）=1.09，95%CI=（1.04，1.13），P<0.001]，但费用更高[SMD=8.58，95%CI=（5.27，11.89），P<0.001]。与OG相比，RG患者年龄显著更大[SMD=0.46，95%CI=（0.26，0.66），P<0.001]，手术时间更长[SMD=3.96，95%CI=（2.38，5.55），P<0.001]，住院时间更短[SMD=-0.93，95%CI=（-1.62，-0.25），P<0.05]。
腹腔镜和机器人辅助手术都是安全的微创操作策略。机器人辅助手术可能会因其优势而逐渐超越并有可能取代腹腔镜手术。应积累更多机器人辅助手术的经验以应对意外的复杂性，从而在儿童更年幼时手术更稳定。
