McKechnie Tyler, Khamar Jigish, Chu Christopher, Hatamnejad Amin, Jessani Ghazal, Lee Yung, Doumouras Aristithes, Amin Nalin, Hong Dennis, Eskicioglu Cagla
Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
ANZ J Surg. 2025 Apr;95(4):675-689. doi: 10.1111/ans.19319. Epub 2025 Jan 28.
Obesity poses significant challenges in colorectal surgery, affecting operative difficulty and postoperative recovery. The choice of minimally invasive approach for this patient population remains a challenge during preoperative planning. This review aims to provide an updated synthesis of studies comparing laparoscopic and robotic approaches for adult patients with obesity undergoing colorectal surgery.
MEDLINE, Embase and CENTRAL were searched up to August 2023. Articles were included if they compared laparoscopic and robotic colorectal surgery outcomes in adults with obesity (BMI ≥30 kg/m). Outcomes included overall postoperative morbidity, conversion to laparotomy, and operative time. Inverse variance random-effects meta-analyses were used to pool effect estimates.
After screening 2187 citations, 10 observational studies were included with 3281 patients with obesity undergoing robotic surgery (mean age: 58.1 years, female: 43.9%) and 11 369 patients with obesity undergoing laparoscopic surgery (mean age: 58 years, female: 53.2%). Robotic surgery resulted in longer operative times (MD 46.71 min, 95% CI 33.50-59.92, p < 0.01, I = 93.79%) with statistically significant reductions in conversions to laparotomy (RR 0.50, 95% CI 0.39-0.65, p < 0.01, I = 67.15%). No significant differences were seen in postoperative morbidity (RR 0.94, 95% CI 0.82-1.08, p = 0.40, I = 36.08%).
These data suggest that robotic colorectal surgery in patients with obesity may reduce the risk for conversion to laparotomy, but at the expense of increased operative times and with no overt benefits in postoperative outcomes. Further high quality randomized controlled trials assessing the utility of robotic surgery in patients with obesity undergoing colorectal surgery are warranted.
肥胖给结直肠手术带来了重大挑战，影响手术难度和术后恢复。对于这一患者群体，在术前规划中选择微创方法仍然是一项挑战。本综述旨在提供关于比较腹腔镜和机器人手术方法用于肥胖成年患者结直肠手术的研究的最新综合分析。
检索截至2023年8月的MEDLINE、Embase和CENTRAL数据库。纳入比较肥胖成年患者（BMI≥30kg/m²）腹腔镜和机器人结直肠手术结果的文章。结果包括总体术后发病率、中转开腹率和手术时间。采用逆方差随机效应荟萃分析来汇总效应估计值。
在筛选2187篇文献后，纳入了10项观察性研究，其中3281例肥胖患者接受机器人手术（平均年龄：58.1岁，女性：43.9%），11369例肥胖患者接受腹腔镜手术（平均年龄：58岁，女性：53.2%）。机器人手术导致手术时间更长（MD 46.71分钟，95%CI 33.50 - 59.92，p < 0.01，I² = 93.79%），中转开腹率有统计学显著降低（RR 0.50，95%CI 0.39 - 0.65，p < 0.01，I² = 67.15%）。术后发病率无显著差异（RR 0.94，95%CI 0.82 - 1.08，p = 0.40，I² = 36.08%）。
这些数据表明，肥胖患者的机器人结直肠手术可能降低中转开腹的风险，但代价是手术时间增加，且术后结果无明显益处。有必要进行进一步高质量的随机对照试验，以评估机器人手术在肥胖患者结直肠手术中的效用。
