Department of Upper Gastrointestinal Surgery, Portsmouth Hospitals University NHS Trust, Cosham, Portsmouth, PO6 3LY, UK.
J Robot Surg. 2023 Oct;17(5):1967-1977. doi: 10.1007/s11701-023-01662-3. Epub 2023 Jul 13.
Laparoscopic cholecystectomy has become the standard of care for the treatment of symptomatic gallstone disease. In the context of the increasing uptake of robotic surgery, robotic cholecystectomy has seen a substantial growth over the past decades. Despite this, a formal assessment of the evidence for this practice remains elusive and a randomised controlled trial is yet to be performed. This paper reviews the evidence to date for robotic multiport cholecystectomy compared to conventional multiport cholecystectomy. This systematic review was performed conducted using the Medline, Embase and Cochrane databases; in line with the PRISMA guideline. All articles that compared robotic and conventional laparoscopic cholecystectomy were included. The studies were assessed with regards to operative outcomes, postoperative recovery and complications. Fourteen studies were included, describing a total of 3002 patients. There was no difference in operative blood loss, complication rates, incidence of bile duct injury or length of hospital stay between the robotic and laparoscopic groups. The operative time for robotic cholecystectomy was longer, whereas the risk of conversion to open surgery was lower. There was marked variation in definitions of measured outcomes, and most studies lacked data on training and quality assessment, leading to substantial heterogeneity of the data. Available evidence on multiport robotic cholecystectomy compared to conventional laparoscopic cholecystectomy is scarce and the quality of the available studies is generally poor. Results suggest longer operating time for robotic cholecystectomy, although many studies included the learning curve period. Postoperative recovery and complications were similar in both groups.
腹腔镜胆囊切除术已成为治疗有症状胆石病的标准治疗方法。在机器人手术日益普及的背景下，机器人胆囊切除术在过去几十年中得到了迅猛发展。尽管如此，对于这种手术实践的证据进行正式评估仍然难以捉摸，而且尚未进行随机对照试验。本文回顾了迄今为止关于机器人多孔胆囊切除术与传统多孔胆囊切除术的证据。这项系统评价是使用 Medline、Embase 和 Cochrane 数据库按照 PRISMA 指南进行的。所有比较机器人和传统腹腔镜胆囊切除术的研究都包括在内。这些研究评估了手术结果、术后恢复和并发症。共纳入 14 项研究，描述了总共 3002 名患者。机器人组和腹腔镜组在手术出血量、并发症发生率、胆管损伤发生率或住院时间方面无差异。机器人胆囊切除术的手术时间较长，而转为开放手术的风险较低。测量结果的定义存在明显差异，并且大多数研究缺乏关于培训和质量评估的数据，导致数据的异质性很大。关于多孔机器人胆囊切除术与传统腹腔镜胆囊切除术的比较，现有证据稀缺，现有研究的质量普遍较差。结果表明，机器人胆囊切除术的手术时间较长，尽管许多研究都包括了学习曲线期。两组的术后恢复和并发症相似。
