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Meta-Analysis
. 2014 Apr 26:12:122.
doi: 10.1186/1477-7819-12-122.

Robotic-assisted versus laparoscopic colorectal surgery: a meta-analysis of four randomized controlled trials

Guixiang Liao, Zhihong Zhao, Shuhui Lin, Rong Li, Yawei Yuan  1 , Shasha Du, Jiarong Chen, Haijun Deng
Affiliations
Meta-Analysis

Robotic-assisted versus laparoscopic colorectal surgery: a meta-analysis of four randomized controlled trials

Guixiang Liao et al. World J Surg Oncol. .

Abstract

Background: Robotic-assisted laparoscopy is popularly performed for colorectal disease. The objective of this meta-analysis was to compare the safety and efficacy of robotic-assisted colorectal surgery (RCS) and laparoscopic colorectal surgery (LCS) for colorectal disease based on randomized controlled trial studies.

Methods: Literature searches of electronic databases (Pubmed, Web of Science, and Cochrane Library) were performed to identify randomized controlled trial studies that compared the clinical or oncologic outcomes of RCS and LCS. This meta-analysis was performed using the Review Manager (RevMan) software (version 5.2) that is provided by the Cochrane Collaboration. The data used were mean differences and odds ratios for continuous and dichotomous variables, respectively. Fixed-effects or random-effects models were adopted according to heterogeneity.

Results: Four randomized controlled trial studies were identified for this meta-analysis. In total, 110 patients underwent RCS, and 116 patients underwent LCS. The results revealed that estimated blood losses (EBLs), conversion rates and times to the recovery of bowel function were significantly reduced following RCS compared with LCS. There were no significant differences in complication rates, lengths of hospital stays, proximal margins, distal margins or harvested lymph nodes between the two techniques.

Conclusions: RCS is a promising technique and is a safe and effective alternative to LCS for colorectal surgery. The advantages of RCS include reduced EBLs, lower conversion rates and shorter times to the recovery of bowel function. Further studies are required to define the financial effects of RCS and the effects of RCS on long-term oncologic outcomes.

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Figures

Figure 1
Figure 1
Flow chart of the literature search.
Figure 2
Figure 2
Risk of bias graph. (+), low risk of bias; (-), high risk of bias; (?), unclear risk of bias.
Figure 3
Figure 3
Risk of bias summary.
Figure 4
Figure 4
Meta-analysis of the operation times shown as a forest plot between robotic-assisted colorectal surgery (RCS) and laparoscopic colorectal surgery (LCS). The mean differences with 95% CIs are shown.
Figure 5
Figure 5
Meta-analysis of the EBLs shown as a forest plot between robotic-assisted colorectal surgery (RCS) and laparoscopic colorectal surgery (LCS). The mean differences with 95% CIs are shown.
Figure 6
Figure 6
Meta-analysis of the conversion rates shown as a forest plot between robotic-assisted colorectal surgery (RCS) and laparoscopic colorectal surgery (LCS). The odds ratios with 95% CIs are shown.
Figure 7
Figure 7
Meta-analysis of the times to the recovery of bowel function shown as a forest plot between robotic-assisted colorectal surgery (RCS) and laparoscopic colorectal surgery (LCS). The mean differences with 95% CIs are shown.
Figure 8
Figure 8
Meta-analysis of length of hospital stays shown as a forest plot between robotic-assisted colorectal surgery (RCS) and laparoscopic colorectal surgery (LCS). The mean differences with 95% CIs are shown.
Figure 9
Figure 9
Meta-analysis of the complication rates shown as a forest plot between robotic-assisted colorectal surgery (RCS) and laparoscopic colorectal surgery (LCS). The odds ratios with 95% CIs are shown.
Figure 10
Figure 10
Meta-analysis of the proximal margins shown as a forest plot between robotic-assisted colorectal surgery (RCS) and laparoscopic colorectal surgery (LCS). The mean differences with the 95% CIs are shown.
Figure 11
Figure 11
Meta-analysis of the distal margins shown as a forest plot between robotic-assisted colorectal surgery (RCS) and laparoscopic colorectal surgery (LCS). The mean differences with the 95% CIs are shown.
Figure 12
Figure 12
Meta-analysis of the harvested lymph nodes shown as a forest plot between robotic-assisted colorectal surgery (RCS) and laparoscopic colorectal surgery (LCS). The mean differences with the 95% CIs are shown.
Figure 13
Figure 13
Funnel plot used to assess a fixed-effects model of the results of all of the selected studies regarding the complications of robotic-assisted colorectal surgery (RCS) and laparoscopic colorectal surgery (LCS). SE, standard error.
See this image and copyright information in PMC

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