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机器人手术与腹腔镜手术治疗抗反流和食管裂孔疝:一项短期结局和成本的系统文献回顾和荟萃分析。

Robotic surgery versus Laparoscopic surgery for anti-reflux and hiatal hernia surgery: a short-term outcomes and cost systematic literature review and meta-analysis.

机构信息

Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.

MEDCIDS - Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, Porto, Portugal.

出版信息

Langenbecks Arch Surg. 2024 Jun 6;409(1):175. doi: 10.1007/s00423-024-03368-y.

DOI:10.1007/s00423-024-03368-y
PMID:38842610
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11156741/
Abstract

PURPOSE

The objective of this study is to compare the operative time, intraoperative complications, length of stay, readmission rates, overall complications, mortality, and cost associated with Robotic Surgery (RS) and Laparascopic Surgery (LS) in anti-reflux and hiatal hernia surgery.

METHODS

A comprehensive literature search was conducted using MEDLINE (via PubMed), Web of Science and Scopus databases. Studies comparing short-term outcomes and cost between RS and LS in patients with anti-reflux and hiatal hernia were included. Data on operative time, complications, length of stay, readmission rates, overall complications, mortality, and cost were extracted. Quality assessment of the included studies was performed using the MINORS scale.

RESULTS

Fourteen retrospective observational studies involving a total of 555,368 participants were included in the meta-analysis. The results showed no statistically significant difference in operative time, intraoperative complications, length of stay, readmission rates, overall complications, and mortality between RS and LS. However, LS was associated with lower costs compared to RS.

CONCLUSION

This systematic review and meta-analysis demonstrates that RS has non-inferior short-term outcomes in anti-reflux and hiatal hernia surgery, compared to LS. LS is more cost-effective, but RS offers potential benefits such as improved visualization and enhanced surgical techniques. Further research, including randomized controlled trials and long-term outcome studies, is needed to validate and refine these findings.

摘要

目的

本研究旨在比较抗反流和食管裂孔疝手术中机器人手术(RS)和腹腔镜手术(LS)的手术时间、术中并发症、住院时间、再入院率、总并发症、死亡率和相关成本。

方法

使用 MEDLINE(通过 PubMed)、Web of Science 和 Scopus 数据库进行全面的文献检索。纳入比较 RS 和 LS 在抗反流和食管裂孔疝患者中短期结局和成本的研究。提取手术时间、并发症、住院时间、再入院率、总并发症、死亡率和成本数据。使用 MINORS 量表对纳入的研究进行质量评估。

结果

纳入的meta 分析共包括 14 项回顾性观察研究,总计 555368 名参与者。结果显示,RS 和 LS 之间的手术时间、术中并发症、住院时间、再入院率、总并发症和死亡率无统计学差异。然而,与 RS 相比,LS 成本更低。

结论

本系统评价和 meta 分析表明,RS 在抗反流和食管裂孔疝手术中具有非劣效的短期结局。LS 更具成本效益,但 RS 提供了一些潜在的益处,如改善可视化和增强手术技术。需要进一步的研究,包括随机对照试验和长期结局研究,以验证和完善这些发现。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/47e7/11156741/25484b71006f/423_2024_3368_Fig7_HTML.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/47e7/11156741/25484b71006f/423_2024_3368_Fig7_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/47e7/11156741/34b842e7d5ed/423_2024_3368_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/47e7/11156741/365c8ee7b1ea/423_2024_3368_Fig2_HTML.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/47e7/11156741/345d0ee5282d/423_2024_3368_Fig6_HTML.jpg
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