Department of Surgery, University of South Florida, Tampa, FL, 33620, USA.
Surg Endosc. 2024 May;38(5):2371-2382. doi: 10.1007/s00464-024-10773-3. Epub 2024 Mar 25.
Despite recent advancements, the advantage of robotic surgery over other traditional modalities still harbors academic inquiries. We seek to take a recently published high-profile narrative systematic review regarding robotic surgery and add meta-analytic tools to identify further benefits of robotic surgery.
Data from the published systematic review were extracted and meta-analysis were performed. A fixed-effect model was used when heterogeneity was not significant (Chi p ≥ 0.05, I ≤ 50%) and a random-effects model was used when heterogeneity was significant (Chi p < 0.05, I > 50%). Forest plots were generated using RevMan 5.3 software.
Robotic surgery had comparable overall complications compared to laparoscopic surgery (p = 0.85), which was significantly lower compared to open surgery (odds ratio 0.68, p = 0.005). Compared to laparoscopic surgery, robotic surgery had fewer open conversions (risk difference - 0.0144, p = 0.03), shorter length of stay (mean difference - 0.23 days, p = 0.01), but longer operative time (mean difference 27.98 min, p < 0.00001). Compared to open surgery, robotic surgery had less estimated blood loss (mean difference - 286.8 mL, p = 0.0003) and shorter length of stay (mean difference - 1.69 days, p = 0.001) with longer operative time (mean difference 44.05 min, p = 0.03). For experienced robotic surgeons, there were less overall intraoperative complications (risk difference - 0.02, p = 0.02) and open conversions (risk difference - 0.03, p = 0.04), with equivalent operative duration (mean difference 23.32 min, p = 0.1) compared to more traditional modalities.
Our study suggests that compared to laparoscopy, robotic surgery may improve hospital length of stay and open conversion rates, with added benefits in experienced robotic surgeons showing lower overall intraoperative complications and comparable operative times.
尽管最近取得了进展，但机器人手术相对于其他传统方式的优势仍然存在学术上的疑问。我们旨在对最近发表的一篇关于机器人手术的高影响力叙事性系统评价进行研究，并添加荟萃分析工具，以确定机器人手术的进一步优势。
提取已发表系统评价中的数据，并进行荟萃分析。当异质性不显著（Chi p ≥ 0.05，I ≤ 50%）时，使用固定效应模型；当异质性显著（Chi p < 0.05，I > 50%）时，使用随机效应模型。使用 RevMan 5.3 软件生成森林图。
机器人手术的总体并发症与腹腔镜手术相当（p = 0.85），明显低于开放手术（比值比 0.68，p = 0.005）。与腹腔镜手术相比，机器人手术的中转开放手术更少（风险差异 -0.0144，p = 0.03），住院时间更短（平均差 -0.23 天，p = 0.01），但手术时间更长（平均差 27.98 分钟，p < 0.00001）。与开放手术相比，机器人手术的估计失血量更少（平均差 -286.8 毫升，p = 0.0003），住院时间更短（平均差 -1.69 天，p = 0.001），手术时间更长（平均差 44.05 分钟，p = 0.03）。对于经验丰富的机器人外科医生，总体术中并发症更少（风险差异 -0.02，p = 0.02），中转开放手术更少（风险差异 -0.03，p = 0.04），手术时间相当（平均差 23.32 分钟，p = 0.1），与更传统的方式相比。
我们的研究表明，与腹腔镜手术相比，机器人手术可能会改善住院时间和中转开放手术的发生率，而经验丰富的机器人外科医生则具有更低的总体术中并发症和相当的手术时间。
