Roy Joanna M, Musmar Basel, Fuleihan Antony A, Atallah Elias, Mina Shady, Patel Shray, Jaffer Athina, Tjoumakaris Stavropoula I, Gooch Michael R, Rosenwasser Robert H, Jabbour Pascal M
Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Division Chief of Neurovascular Surgery and Endovascular Neurosurgery, The Angela and Richard T. Clark Distinguished Professor of Neurological Surgery, Thomas Jefferson University Hospital, 901 Walnut Street 3Rd Floor, Philadelphia, PA, 19107, USA.
Neurosurg Rev. 2024 Dec 6;47(1):890. doi: 10.1007/s10143-024-03141-1.
Endovascular procedures are associated with improved outcomes and patient satisfaction compared to open surgery in selected cases. However, this is at the cost of increased radiation exposure. Robotic procedures are thought to minimize radiation exposure and may confer procedural efficacy due to the lack of operator fatigue. Our systematic review and meta-analysis compares procedural efficacy of robotic versus manual diagnostic and stenting procedures.
PubMed, Embase and Scopus were searched in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Articles reporting comparative outcomes between robotic and manual diagnostic and stenting procedures were included. Articles related to stereotactic radiosurgery and open surgical procedures were excluded. The Newcastle Ottawa Scale was used to assess risk of bias. Effect sizes (mean difference for robotic and manual procedures) and variances were calculated for procedure time. The random effects model was used to calculate pooled estimates for technical success using the "metafor" package in R (R software v4.2.1, Vienna, Austria).
6465 articles were identified through our search strategy. After 4683 articles were excluded through a title and abstract screen and 30 articles were excluded through a full text review, 3 articles reporting outcomes in 175 patients undergoing robotic procedures and 185 patients undergoing manual procedures were included. These studies reported comparative outcomes for carotid artery stenting, diagnostic cerebral angiograms and transverse sinus stenting. There was no significant difference in procedure time (mean difference: 0.14 min [95% confidence interval (CI): -0.58, 0.86, p = 0.64, I = 68%]. Technical success was 0.05-fold lower for robotic procedures compared to manual procedures [95% CI: 0.00- 0.84), P = 0.04]. One study was considered high quality using the NOS.
Robotic procedures confer significantly lower rates of technical success with no significant difference in procedure time. Further studies are necessary to draw conclusions about potential benefits of robotic procedures including lower radiation exposure.
在某些特定病例中，与开放手术相比，血管内手术的治疗效果更好，患者满意度更高。然而，这是以增加辐射暴露为代价的。机器人手术被认为可以将辐射暴露降至最低，并且由于缺乏操作者疲劳，可能具有手术疗效。我们的系统评价和荟萃分析比较了机器人手术与手动诊断和支架置入手术的手术疗效。
按照系统评价和荟萃分析的首选报告项目（PRISMA）声明，检索了PubMed、Embase和Scopus数据库。纳入报告机器人手术与手动诊断和支架置入手术比较结果的文章。排除与立体定向放射外科手术和开放手术相关的文章。使用纽卡斯尔渥太华量表评估偏倚风险。计算手术时间的效应量（机器人手术与手动手术的平均差异）和方差。使用R软件（R软件v4.2.1，奥地利维也纳）中的“metafor”包，采用随机效应模型计算技术成功率的合并估计值。
通过我们的检索策略共识别出6465篇文章。通过标题和摘要筛选排除4683篇文章，通过全文审查排除30篇文章后，纳入了3篇报告175例接受机器人手术和185例接受手动手术患者结果的文章。这些研究报告了颈动脉支架置入术、诊断性脑血管造影和横窦支架置入术的比较结果。手术时间无显著差异（平均差异：0.14分钟[95%置信区间（CI）：-0.58，0.86，p = 0.64，I = 68%]）。与手动手术相比，机器人手术的技术成功率低0.05倍[95%CI：0.00 - 0.84），P = 0.04]。使用NOS评估，一项研究被认为质量高。
机器人手术的技术成功率显著较低，手术时间无显著差异。需要进一步研究以得出关于机器人手术潜在益处（包括更低的辐射暴露）的结论。
