Iacovazzo Carmine, Buonanno Pasquale, Massaro Maria, Ianniello Marilena, de Siena Andrea Uriel, Vargas Maria, Marra Annachiara
Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples, Federico II, 80131 Naples, Italy.
J Pers Med. 2023 Aug 25;13(9):1297. doi: 10.3390/jpm13091297.
The use of robotic surgery is attracting ever-growing interest for its potential advantages such as small incisions, fine movements, and magnification of the operating field. Only a few randomized controlled trials (RCTs) have explored the differences in perioperative outcomes between the two approaches.
We screened the main online databases from inception to May 2023. We included studies in English enrolling adult patients undergoing elective gastrointestinal surgery. We used the following exclusion criteria: surgery with the involvement of thoracic esophagus, and patients affected by severe heart, pulmonary and end-stage renal disease. We compared intra- and post-operative complications, length of hospitalization, and costs between laparoscopic and robotic approaches.
A total of 18 RCTs were included. We found no differences in the rate of anastomotic leakage, cardiovascular complications, estimated blood loss, readmission, deep vein thrombosis, length of hospitalization, mortality, and post-operative pain between robotic and laparoscopic surgery; post-operative pneumonia was less frequent in the robotic approach. The conversion to open surgery was less frequent in the robotic approach, which was characterized by shorter time to first flatus but higher operative time and costs.
The robotic gastrointestinal surgery has some advantages compared to the laparoscopic technique such as lower conversion rate, faster recovery of bowel movement, but it has higher economic costs.
机器人手术因其潜在优势，如切口小、动作精细和手术视野放大等，正吸引着越来越多的关注。仅有少数随机对照试验（RCT）探讨了这两种手术方式围手术期结果的差异。
我们检索了从建库至2023年5月的主要在线数据库。纳入了以英文发表的、纳入接受择期胃肠手术成年患者的研究。我们采用了以下排除标准：涉及胸段食管的手术，以及患有严重心脏、肺部疾病和终末期肾病的患者。我们比较了腹腔镜手术和机器人手术的术中及术后并发症、住院时间和费用。
共纳入18项随机对照试验。我们发现机器人手术和腹腔镜手术在吻合口漏发生率、心血管并发症、估计失血量、再入院率、深静脉血栓形成、住院时间、死亡率和术后疼痛方面无差异；机器人手术术后肺炎的发生率较低。机器人手术中转开腹手术的发生率较低，其特点是首次排气时间较短，但手术时间和费用较高。
与腹腔镜技术相比，机器人胃肠手术具有一些优势，如较低的中转率、更快的肠道运动恢复，但经济成本较高。
