Schnittka Emma, Lanpher Nick W, Cushing-Murray Jessica, Decker Trevor, Patel Praful G
Medicine, Alabama College of Osteopathic Medicine, Dothan, USA.
Obstetrics and Gynecology, Southeast Health Medical Center, Dothan, USA.
Cureus. 2023 Feb 6;15(2):e34702. doi: 10.7759/cureus.34702. eCollection 2023 Feb.
Robotic single-site hysterectomy (RSSH) has emerged as a novel surgical approach for the treatment of endometrial cancer and atypical endometrial hyperplasia (AEH). Current research regarding the benefits of RSSH compared to robotic multiport hysterectomy (RMPH) for these indications has been inconclusive. Our team sought to compare surgical outcomes between these two approaches of robotic hysterectomy via systematic review and meta-analysis to ensure optimal surgical practices. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Checklist guided our review. MEDLINE, Clinicaltrials.gov, and Cochrane Library were searched, yielding 59 results. Articles were filtered by title and abstract and then reviewed in full for inclusion and exclusion criteria. Inclusion criteria required that (1) studies compared outcomes for RSSH and RMPH, (2) hysterectomy was indicated for endometrial cancer or hyperplasia with atypia, and (3) studies were available in English. Excluded studies (1) compared single-site and multiport laparoscopic approaches, (2) compared robotic approaches to laparoscopic or abdominal (open) techniques, and (3) employed hysterectomy for benign conditions. Publication bias was assessed using the Egger Regression Correlation analysis. Four studies complied with the selection criteria, comprising 138 patients in the RSSH group and 259 in the RMPH group. Similar outcomes were noted across all measures, including conversion rate (relative risk [RR] = 1.84 and confidence interval [CI] = 0.99-3.43), blood loss (Cohen's = 1.05 and = 18.62), operating time (Cohen's = 0.29 and = 4.38), and length of hospital stay (Cohen's = 1.06 and = 3.86). Publication bias was deemed minimal as indicated by Egger regression values of less than 0.05. These findings suggest that either a surgical approach or AEH with the proper standard of care can provide patients with endometrial cancer.
机器人单孔子宫切除术（RSSH）已成为治疗子宫内膜癌和非典型子宫内膜增生（AEH）的一种新型手术方法。目前关于RSSH与机器人多孔子宫切除术（RMPH）相比在这些适应症方面的益处的研究尚无定论。我们的团队试图通过系统评价和荟萃分析比较这两种机器人子宫切除术方法的手术结果，以确保最佳手术实践。系统评价和荟萃分析的首选报告项目（PRISMA）2020清单指导了我们的评价。检索了MEDLINE、Clinicaltrials.gov和Cochrane图书馆，得到59个结果。文章通过标题和摘要进行筛选，然后根据纳入和排除标准进行全文审查。纳入标准要求：（1）研究比较了RSSH和RMPH的结果；（2）子宫切除术适用于子宫内膜癌或非典型增生；（3）研究为英文。排除的研究：（1）比较单孔和多孔腹腔镜手术方法；（2）比较机器人手术方法与腹腔镜或腹部（开放）技术；（3）因良性疾病进行子宫切除术。使用Egger回归相关分析评估发表偏倚。四项研究符合选择标准，RSSH组138例患者，RMPH组259例患者。所有指标的结果相似，包括转化率（相对风险[RR]=1.84，置信区间[CI]=0.99-3.43）、失血量（Cohen's d=1.05，标准差=18.62）、手术时间（Cohen's d=0.29，标准差=4.38）和住院时间（Cohen's d=1.06，标准差=3.86）。Egger回归值小于0.05表明发表偏倚最小。这些发现表明，任何一种手术方法或采用适当护理标准的AEH都可以为子宫内膜癌患者提供治疗。
