机器人辅助增强视野完全腹膜外（eTEP）与经腹肌后（TARM又名TARUP）腹疝补片修补术的比较：一项系统评价和荟萃分析

Comparison of Robot-assisted Enhanced-view Totally Extraperitoneal (eTEP) and Transabdominal Retromuscular (TARM aka TARUP) Ventral Hernia Mesh Repair: A Systematic Review and Meta-Analysis.

作者信息

Brucchi Francesco, De Troyer Annabelle, Sassun Richard, Dionigi Gianlorenzo, Muysoms Filip

机构信息

General Surgery Residency Program, University of Milan, Milan, Italy.

Division of Surgery, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.

出版信息

J Abdom Wall Surg. 2025 Jul 4;4:14723. doi: 10.3389/jaws.2025.14723. eCollection 2025.

DOI:10.3389/jaws.2025.14723

PMID:40689023

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12270933/

Abstract

BACKGROUND

This systematic review and meta-analysis compares robotic eTEP and TARM/TARUP in terms of complications, operative time, infections, length of stay, seroma, and short-term recurrence rates.

METHODS

A systematic review was conducted following PRISMA guidelines, searching MEDLINE, Embase, and CENTRAL until January 30, 2025. Studies comparing r-eTEP and r-TARM/TARUP in adults with ventral hernia were included. Primary outcomes were operative time and postoperative complications. Secondary outcomes included wound complications, length of stay, readmission, pain, and short-term recurrence. A random-effects model was used for meta-analysis, and study quality was assessed via the Methodological Index for Non-randomised Studies (MINORS) score.

RESULTS

Three studies (308 patients: r-eTEP 176, r-TARM/TARUP 132) were included. Overall complications were lower with r-eTEP (RD: -0.17; 95% CI: -0.27 to -0.07; p = 0.001) and as was the case for minor complications (RD: -0.14; 95% CI: -0.22 to -0.06; p = 0.0008). No significant differences were found in major complications, SSI, recurrence, or 30-day readmission. Operative time was shorter with r-eTEP (MD: -25.66 min; 95% CI: -51.18 to -0.14; p = 0.05, I = 88%). Seroma formation was lower with r-eTEP (RD: -0.08; 95% CI: -0.15 to -0.02; p = 0.01). Length of stay was shorter with r-eTEP (MD: -2.64 days; 95% CI: -4.06 to -1.22; p = 0.004, I = 98%).

CONCLUSION

Evidence remains insufficient to favor one robotic approach over the other. High-quality prospective studies on patient outcomes and long-term recurrence are needed to guide surgical decision-making.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO, identifier CRD420250650879.

摘要

背景

本系统评价和荟萃分析比较了机器人辅助经腹腹膜前修补术（r-eTEP）和经腹网膜瓣修补术/经腹网膜瓣补片修补术（TARM/TARUP）在并发症、手术时间、感染、住院时间、血清肿和短期复发率方面的差异。

方法

按照PRISMA指南进行系统评价，检索MEDLINE、Embase和CENTRAL数据库至2025年1月30日。纳入比较成人腹疝患者r-eTEP和r-TARM/TARUP的研究。主要结局为手术时间和术后并发症。次要结局包括伤口并发症、住院时间、再入院、疼痛和短期复发。采用随机效应模型进行荟萃分析，并通过非随机研究方法学指数（MINORS）评分评估研究质量。

结果

纳入三项研究（308例患者：r-eTEP组176例，r-TARM/TARUP组132例）。r-eTEP组总体并发症较低（风险差：-0.17；95%置信区间：-0.27至-0.07；p = 0.001），轻微并发症情况相同（风险差：-0.14；95%置信区间：-0.22至-0.06；p = 0.0008）。在严重并发症、手术部位感染、复发或30天再入院方面未发现显著差异。r-eTEP组手术时间较短（平均差：-25.66分钟；95%置信区间：-51.18至-0.14；p = 0.05，I² = 88%）。r-eTEP组血清肿形成较低（风险差：-0.08；95%置信区间：-0.15至-0.02；p = 0.01）。r-eTEP组住院时间较短（平均差：-2.64天；95%置信区间：-4.06至-1.22；p = 0.004，I² = 98%）。