Tang Kezhong, Zhou Wei, Zhou Yizhao, Li Yongzhou, Liao Li, Dong Xin
Department of Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, PR China.
Department of Surgery, First People's Hospital of Pinghu District, Jiaxing, PR China.
Medicine (Baltimore). 2025 May 23;104(21):e42493. doi: 10.1097/MD.0000000000042493.
Robotic surgery has shown great advantages in many complicated endoscopic operations compared with laparoscopic surgery. However robotic-assisted cholecystectomy (RAC) is still a controversial issue compared with conventional/single-incision laparoscopic cholecystectomy (CLC/SILC). The aim of this study was to compare the safety and efficacy of RAC with CLC/SILC for benign gallbladder disease.
Embase, Medline, Pubmed, and Cochrane library databases were searched to obtain comparative studies evaluating the safety and efficacy between RAC and CLC/SILC. Only randomized trials and non-randomized studies with propensity score matching were included. Statistical analysis was performed through Stata software, random effects models were applied.
A total of 17 studies, including 12 studies for RAC versus CLC and 5 studies for RAC versus SILC, were included in the study. A total of 75,866 patients were included in the study, of whom 37,471 patients underwent RAC, 38,123 patients underwent CLC, and 272 patients underwent SILC. Compared with CLC/SILC, RAC significantly increased operative time (standardized mean difference [SMD] 0.79 minutes; 95% confidence interval [CI] 0.30, 1.28) and hospitalization costs (SMD 1.82; 95% CI 0.27, 3.36). At the same time, RAC significantly reduced conversion rate (relative risk [RR] 0.58; 95% CI 0.52, 0.63). There were no significant differences between the groups in the length of hospital stay (SMD 0.04; 95% CI -0.02, 0.11), intraoperative complications (RR 0.99; 95% CI 0.61, 1.59), estimate blood loss (SMD 0.03; 95% CI -0.19, 0.25), and incisional hernia (RR 2.51; 95% CI 0.69, 9.10).
RAC is a safe and effective procedure with lower conversion rate and comparable rate of complications compared with CLC/SILC.
与腹腔镜手术相比，机器人手术在许多复杂的内镜手术中已显示出巨大优势。然而，与传统/单孔腹腔镜胆囊切除术（CLC/SILC）相比，机器人辅助胆囊切除术（RAC）仍是一个有争议的问题。本研究的目的是比较RAC与CLC/SILC治疗良性胆囊疾病的安全性和有效性。
检索Embase、Medline、Pubmed和Cochrane图书馆数据库，以获取评估RAC与CLC/SILC之间安全性和有效性的比较研究。仅纳入随机试验和采用倾向评分匹配的非随机研究。通过Stata软件进行统计分析，应用随机效应模型。
本研究共纳入17项研究，其中12项为RAC与CLC对比研究，5项为RAC与SILC对比研究。研究共纳入75866例患者，其中37471例患者接受了RAC，38123例患者接受了CLC，272例患者接受了SILC。与CLC/SILC相比，RAC显著增加了手术时间（标准化均数差[SMD]0.79分钟；95%置信区间[CI]0.30，1.28）和住院费用（SMD 1.82；95%CI 0.27，3.36）。同时，RAC显著降低了中转率（相对危险度[RR]0.58；95%CI 0.52，0.63）。两组在住院时间（SMD 0.04；95%CI -0.02，0.11）、术中并发症（RR 0.99；95%CI 0.61，1.59）、估计失血量（SMD 0.03；95%CI -0.19，0.25）和切口疝（RR 2.51；95%CI 0.69，9.10）方面无显著差异。
与CLC/SILC相比，RAC是一种安全有效的手术方法，中转率较低，并发症发生率相当。
