Wang Piao, Zhang Dan, Huang Bin, Zhou Wen-Hao, Wang Chang-Song, Zhao Shao-Yong, Su Song, Jiang Xiao-Zhong
Department of Hepatobiliary and Pancreatic Surgery, The Second People's Hospital of Yibin, Yibin, Sichuan, China.
Department of Thyroid and Breast Surgery, The Third People's Hospital of Yibin, Yibin, Sichuan, China.
BJS Open. 2025 Mar 4;9(2). doi: 10.1093/bjsopen/zrae141.
Robotic techniques can theoretically overcome the limitations of laparoscopic liver resection and are currently recognized as safe options; however, it is not known which approach is better. The purpose of this study was to compare the advantages of robotic hepatectomy and laparoscopic hepatectomy.
Electronic databases (the Cochrane Library, PubMed (MEDLINE), Embase and Web of Science) were systematically searched from January 2000 to August 2023 for eligible studies that compared robotic hepatectomy and laparoscopic hepatectomy. Studies that met the inclusion criteria were then reviewed systematically. The reported data were aggregated statistically using RevMan 5.4 software. The parameters of interest included intraoperative, postoperative, survival and financial outcomes. Subgroup analysis was performed according to the type and difficulty level of hepatectomy and the study setting.
A total of 26 propensity-score matching comparative trials met the inclusion criteria, which comprised 9355 participants (robotic hepatectomy versus laparoscopic hepatectomy: 3938 versus 5417) in the meta-analysis. For surgical outcomes, lower blood loss, lower open conversion rate and higher R0 resection rate were observed in the robotic hepatectomy group compared with the laparoscopic hepatectomy group (mean difference (MD) -86.22, 95% c.i. -116.49 to -55.95, I² = 87%, P < 0.001; OR 0.51, 95% c.i. 0.38 to 0.69, I² = 40%, P < 0.001; OR 1.31, 95% c.i. 1.03 to 1.67, I² = 0%, P = 0.030 respectively). The lower blood loss (major hepatectomy group: MD -56.88, 95% c.i. -109.09 to -4.28, I² = 76%, P = 0.030; IWATE score (advanced/expert more than 80%) group: MD -0.61, 95% c.i. -1.14 to -0.08, I² = 95%, P < 0.001) and lower open conversion rate (major hepatectomy group: OR 0.41, 95% c.i. 0.30 to 0.56, I² = 0%, P < 0.001; IWATE score (advanced/expert less than 80%) group: OR 0.52, 95% c.i. 0.36 to 0.75, I² = 0%, P = 0.659) advantage persisted across subgroup analyses.
The robotic approach had advantages to laparoscopic in terms of lower blood loss and reduced rates of open conversion, especially in difficult hepatectomies.
机器人技术理论上可以克服腹腔镜肝切除术的局限性，目前被认为是安全的选择；然而，尚不清楚哪种方法更好。本研究的目的是比较机器人肝切除术和腹腔镜肝切除术的优势。
系统检索2000年1月至2023年8月的电子数据库（Cochrane图书馆、PubMed（MEDLINE）、Embase和科学网），以查找比较机器人肝切除术和腹腔镜肝切除术的符合条件的研究。然后对符合纳入标准的研究进行系统评价。使用RevMan 5.4软件对报告的数据进行统计学汇总。感兴趣的参数包括术中、术后、生存和财务结果。根据肝切除术的类型和难度水平以及研究背景进行亚组分析。
共有26项倾向评分匹配的比较试验符合纳入标准，在荟萃分析中包括9355名参与者（机器人肝切除术与腹腔镜肝切除术：3938例与5417例）。对于手术结果，与腹腔镜肝切除术组相比，机器人肝切除术组的失血量更低、开腹转换率更低、R0切除率更高（平均差（MD）-86.22，95%置信区间-116.49至-55.95，I²=87%，P<0.001；OR 0.51，95%置信区间0.38至0.69，I²=40%，P<0.001；OR 1.31，95%置信区间1.03至1.67，I²=0%，P=0.030）。较低的失血量（大肝切除术组：MD -56.88，95%置信区间-109.09至-4.28，I²=76%，P=0.030；岩手评分（高级/专家超过80%）组：MD -0.61，95%置信区间-1.14至-0.08，I²=95%，P<0.001）和较低的开腹转换率（大肝切除术组：OR 0.41，95%置信区间0.30至0.56，I²=0%，P<0.001；岩手评分（高级/专家低于80%）组：OR 0.52，95%置信区间0.36至0.75，I²=0%，P=0.659）优势在亚组分析中持续存在。
机器人手术方法在减少失血量和降低开腹转换率方面比腹腔镜手术具有优势，尤其是在困难的肝切除术中。
