Journal Article

Comparative clinical outcomes of robot-assisted liver resection versus laparoscopic liver resection: A meta-analysis

Yuan, Qihang, Xu, Yao, Zhang, Lilong, Wang, Weixing

2020

Overview

As an emerging technology, robot-assisted surgical system has some potential merits in many complicated endoscopic procedures compared with laparoscopic surgery. But robot-assisted liver resection is still a controversial problem on its advantages compared with laparoscopic liver resection. We aimed to perform the meta-analysis to assess and compare the clinical outcomes of robot-assisted and laparoscopic liver resection. We searched PubMed, Cochrane Library, Embase databases, Clinicaltrials, and Opengrey through March 24, 2020, including references of qualifying articles. English-language, original investigations in humans about robot-assisted and laparoscopic hepatectomy were included. Titles, abstracts, and articles were reviewed by at least 2 independent readers. Continuous and dichotomous variables were compared by the weighted mean difference (WMD) and odds ratio (OR), respectively. Of 936 titles identified in our original search, 28 articles met our criteria, involving 3544 patients. Compared with laparoscopy, the robot-assisted groups had longer operative time (WMD: 36.93; 95% CI, 19.74-54.12; P < 0.001), lower conversion rate (OR: 0.63; 95% CI, 0.46-0.87; P = 0.005), higher transfusion rate (WMD: 2.39; 95% CI, 1.51-3.76; P < 0.001) and higher total cost (WMD:0.49; 95% CI, 0.42-0.55; P < 0.001). In addition, the baseline characteristics of patients about largest tumor size was larger (WMD: 0.36; 95% CI, 0.16-0.56; P < 0.001) and malignant lesions rate was higher (WMD: 1.50; 95% CI, 1.21-1.86; P < 0.001) in the robot-assisted versus laparoscopic hepatectomy. The subgroup analysis of minor hepatectomy showed robot-assisted was associated with longer operative time (WMD: 36.00; 95% CI, 12.59-59.41; P = 0.003), longer length of stay (WMD: 0.51; 95% CI, 0.02-1.01; p = 0.04) and higher total cost (WMD: 0.48; 95% CI, 0.25-0.72; P < 0.001) (Table 3); while the subgroup analysis of major hepatectomy showed robot-assisted was associated with lower estimated blood loss (WMD: -122.43; 95% CI, -151.78--93.08; P < 0.001). Our meta-analysis revealed that robot-assisted was associated with longer operative time, lower conversion rate, higher transfusion rate and total cost, and robot-assisted has certain advantages in major hepatectomy compared with laparoscopic hepatectomy.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Bias / Blood Loss, Surgical - statistics & numerical data / Blood Transfusion - statistics & numerical data / Care and treatment / Clinical outcomes / Comparative analysis / Continuity (mathematics) / Conversion / Conversion to Open Surgery - statistics & numerical data / Excision (Surgery) / Hepatectomy / Hepatectomy - adverse effects / Hepatectomy - economics / Hepatectomy - methods / Hepatectomy - statistics & numerical data / Hospitals / Humans / Laparoscopy / Laparoscopy - adverse effects / Laparoscopy - economics / Laparoscopy - methods / Laparoscopy - statistics & numerical data / Length of Stay - statistics & numerical data / Liver / Liver diseases / Liver Neoplasms - economics / Liver Neoplasms - surgery / Medicine and Health Sciences / Meta-analysis / New technology / Operative Time / Patients / Physical Sciences / Postoperative Complications - epidemiology / Postoperative Complications - etiology / Research and Analysis Methods / Robotic surgery / Robotic Surgical Procedures - adverse effects / Robotic Surgical Procedures - economics / Robotic Surgical Procedures - methods / Robotic Surgical Procedures - statistics & numerical data / Robots / Subgroups / Surgery / Surgical outcomes / Transfusion / Treatment Outcome / Tumors