Panin S I, Nechay T V, Sazhin A V, Tyagunov A E, Shcherbakov N A, Bykov A V, Melnikov-Makarchuk K Yu, Yuldashev A G, Kuznetsov A A
Department of General Surgery, Volgograd State Medical University, Volgograd, Russia.
Research Institute of Clinical Surgery, Pirogov Russian National Research Medical University, Moscow, Russia.
Front Robot AI. 2023 Sep 13;10:1208611. doi: 10.3389/frobt.2023.1208611. eCollection 2023.
Complicated diverticulitis is a common abdominal emergency that often requires a surgical intervention. The systematic review and meta-analysis below compare the benefits and harms of robotic vs. laparoscopic surgery in patients with complicated colonic diverticular disease. The following databases were searched before 1 March 2023: Cochrane Library, PubMed, Embase, CINAHL, and ClinicalTrials.gov. The internal validity of the selected non-randomized studies was assessed using the ROBINS-I tool. The meta-analysis and trial sequential analysis were performed using RevMan 5.4 (Cochrane Collaboration, London, United Kingdom) and Copenhagen Trial Unit Trial Sequential Analysis (TSA) software (Copenhagen Trial Unit, Center for Clinical Intervention Research, Rigshospitalet, Copenhagen, Denmark), respectively. We found no relevant randomized controlled trials in the searched databases. Therefore, we analyzed 5 non-randomized studies with satisfactory internal validity and similar designs comprising a total of 442 patients (184 (41.6%) robotic and 258 (58.4%) laparoscopic interventions). The analysis revealed that robotic surgery for complicated diverticulitis (CD) took longer than laparoscopy (MD = 42 min; 95% CI: [-16, 101]). No statistically significant differences were detected between the groups regarding intraoperative blood loss (MD = -9 mL; 95% CI: [-26, 8]) and the rate of conversion to open surgery (2.17% or 4/184 for robotic surgery vs. 6.59% or 17/258 for laparoscopy; RR = 0.63; 95% CI: [0.10, 4.00]). The type of surgery did not affect the length of in-hospital stay (MD = 0.18; 95% CI: [-0.60, 0.97]) or the rate of postoperative complications (14.1% or 26/184 for robotic surgery vs. 19.8% or 51/258 for laparoscopy; RR = 0.81; 95% CI: [0.52, 1.26]). No deaths were reported in either group. The meta-analysis suggests that robotic surgery is an appropriate option for managing complicated diverticulitis. It is associated with a trend toward a lower rate of conversion to open surgery and fewer postoperative complications; however, this trend does not reach the level of statistical significance. Since no high quality RCTs were available, this meta-analysis isnot able to provide reliable conclusion, but only a remarkable lack of proper evidence supporting robotic technology. The need for further evidence-based trials is important.
复杂性憩室炎是一种常见的腹部急症，通常需要手术干预。以下系统评价和荟萃分析比较了机器人手术与腹腔镜手术治疗复杂性结肠憩室病患者的利弊。在2023年3月1日前检索了以下数据库：Cochrane图书馆、PubMed、Embase、CINAHL和ClinicalTrials.gov。使用ROBINS-I工具评估所选非随机研究的内部效度。荟萃分析和试验序贯分析分别使用RevMan 5.4（Cochrane协作网，英国伦敦）和哥本哈根试验单位试验序贯分析（TSA）软件（哥本哈根试验单位，临床干预研究中心，丹麦哥本哈根 Rigshospitalet）进行。我们在检索到的数据库中未发现相关的随机对照试验。因此，我们分析了5项内部效度良好且设计相似的非随机研究，共纳入442例患者（184例（41.6%）接受机器人手术，258例（58.4%）接受腹腔镜手术）。分析显示，机器人手术治疗复杂性憩室炎（CD）的时间比腹腔镜手术长（MD = 42分钟；95%CI：[-16, 101]）。两组在术中失血量（MD = -9 mL；95%CI：[-26, 8]）和转为开放手术的比例方面未检测到统计学显著差异（机器人手术为2.17%或4/184，腹腔镜手术为6.59%或17/258；RR = 0.63；95%CI：[0.10, 4.00]）。手术方式对住院时间（MD = 0.18；95%CI：[-0.60, 0.97]）或术后并发症发生率没有影响（机器人手术为14.1%或26/184，腹腔镜手术为19.8%或51/258；RR = 0.81；95%CI：[0.52, 1.26]）。两组均未报告死亡病例。荟萃分析表明，机器人手术是治疗复杂性憩室炎的一种合适选择。它有转为开放手术的比例较低和术后并发症较少的趋势；然而，这种趋势未达到统计学显著水平。由于没有高质量的随机对照试验，该荟萃分析无法提供可靠结论，只是明显缺乏支持机器人技术的适当证据。进一步开展基于证据的试验很重要。
