Department of Surgical Disciplines, All India Institute of Medical Sciences, Room Number 406, Surgery Block, New Delhi, India, 110049.
Clinical Research and Epidemiology, Institute of Liver and Biliary Sciences, New Delhi, India.
Hernia. 2023 Apr;27(2):245-257. doi: 10.1007/s10029-022-02733-4. Epub 2023 Jan 6.
Patient-Reported Outcome Measures (PROM's) are increasingly used to assess surgical outcomes in low-risk surgeries such as minimally invasive primary ventral and incisional hernia repair. The purpose of this meta-analysis was to systematically summarize the available evidence for the effect of laparoscopic versus robotic primary ventral and incisional hernia repair on PROM's.
A systematic review and meta-analysis were performed in accordance with PRISMA guidelines. Randomised control trials, retrospective and prospective studies were included. Medline, Embase, SCOPUS, Web of Science, and Cochrane CENTRAL, and two trial registers were searched. Pooled effect sizes and 95% confidence intervals were calculated using the Mantel-Haenszel method. The overall quality of evidence was assessed using GRADE.
Of the 2728 titles screened, eight studies involving 41,205 participants were included. Return to activities of daily living, return to work day and recurrence rate were statistically better in the robotic group. Length of stay, readmission, postoperative pain, quality of life, body image, and patient satisfaction were similar in both groups. The GRADE rating of the quality of evidence was moderate for postoperative pain and low to very low for the quality of life, length of stay, recurrence and readmission.
The available data of PROM's of laparoscopic and robotic primary ventral and incisional hernia repair is scarce and highly heterogeneous, thus making it difficult to assess the superiority of the laparoscopic technique over the robotic technique. Further studies with uniform reporting of PROM's in laparoscopic and robotic primary ventral and incisional hernia repair are needed.
患者报告的结局测量（PROM）越来越多地用于评估微创原发性腹侧和切口疝修复等低风险手术的手术结果。本荟萃分析的目的是系统总结腹腔镜与机器人原发性腹侧和切口疝修复对 PROM 的影响的现有证据。
根据 PRISMA 指南进行系统评价和荟萃分析。纳入随机对照试验、回顾性和前瞻性研究。检索 Medline、Embase、SCOPUS、Web of Science 和 Cochrane CENTRAL，以及两个试验登记处。使用 Mantel-Haenszel 方法计算汇总效应大小和 95%置信区间。使用 GRADE 评估总体证据质量。
在筛选出的 2728 篇标题中，有 8 项研究涉及 41205 名参与者被纳入。机器人组在恢复日常生活活动、恢复工作天数和复发率方面具有统计学优势。两组的住院时间、再入院、术后疼痛、生活质量、身体形象和患者满意度相似。术后疼痛的证据质量等级评定为中度，生活质量、住院时间、复发和再入院的证据质量等级评定为低至非常低。
腹腔镜和机器人原发性腹侧和切口疝修复的 PROM 数据稀缺且高度异质，因此难以评估腹腔镜技术相对于机器人技术的优势。需要进一步研究腹腔镜和机器人原发性腹侧和切口疝修复中 PROM 的统一报告。
