Robotic versus laparoscopic colorectal surgery

Abstract

Background: Robotic approaches have become increasingly used for colorectal surgery. The aim of this study is to examine the safety and efficacy of robotic colorectal procedures in an adult population.

Study design: A systematic review of articles in both PubMed and Embase comparing laparoscopic and robotic colorectal procedures was performed. Clinical trials and observational studies in an adult population were included. Approaches were evaluated in terms of operative time, length of stay, estimated blood loss, number of lymph nodes harvested, and perioperative complications. Mean net differences and odds ratios were calculated to examine treatment effect of each group.

Results: Two hundred eighteen articles were identified, and 17 met the inclusion criteria, representing 4,342 patients: 920 robotic and 3,422 in the laparoscopic group. Operative time for the robotic approach was 38.849 minutes longer (95% confidence interval: 17.944 to 59.755). The robotic group had lower estimated blood loss (14.17 mL; 95% confidence interval: -27.63 to -1.60), and patients were 1.78 times more likely to be converted to an open procedure (95% confidence interval: 1.24 to 2.55). There was no difference between groups with respect to number of lymph nodes harvested, length of stay, readmission rate, or perioperative complication rate.

Conclusions: The robotic approach to colorectal surgery is as safe and efficacious as conventional laparoscopic surgery. However, it is associated with longer operative time and an increased rate of conversion to laparotomy. Further prospective randomized controlled trials are warranted to examine the cost-effectiveness of robotic colorectal surgery before it can be adopted as the new standard of care.

Keywords: Colorectal surgery; Laparoscopic; Robotic.

Figure 1.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart of literature search and study selection.

Figure 2.

Forest plot and pooled analysis of mean difference in operative time between robotic and laparoscopic approaches. The mean difference in operative time is reported for each study (black square) along with its 95% confidence interval (CI) (horizontal lines). The size of the square represents the weighted contribution of each study, and the diamond in the last line represents the pooled estimate and its 95% CI (width of diamond).

Figure 3.

Forest plot and pooled analysis of mean difference in blood loss between robotic and laparoscopic approaches. The mean difference in blood loss is reported for each study (black square) along with its 95% confidence interval (CI) (horizontal lines). The size of the square represents the weighted contribution of each study, and the diamond in the last line represents the pooled estimate and its 95% CI (width of diamond).

Figure 4.

Forest plot and pooled analysis of mean difference in the number of harvested lymph nodes between robotic and laparoscopic approaches. The mean difference in number of harvested lymph nodes is reported for each study (black square) along with its 95% confidence interval (CI) (horizontal lines). The size of the square represents the weighted contribution of each study, and the diamond in the last line represents the pooled estimate and its 95% CI (width of diamond).

Figure 5.

Forest plot and pooled analysis of mean difference in the number of days until return of bowel function (flatus) between robotic and laparoscopic approaches. The mean difference in the number of days until return of bowel function is reported for each study (black square) along with its 95% confidence interval (CI) (horizontal lines). The size of the square represents the weighted contribution of each study, and the diamond in the last line represents the pooled estimate and its 95% CI (width of diamond).

Figure 6.

Forest plot and pooled analysis of mean difference in the number of days until initiation of soft diet between robotic and laparoscopic approaches. The mean difference in the number of days until initiation of soft diet is reported for each study (black square) along with its 95% confidence interval (CI) (horizontal lines). The size of the square represents the weighted contribution of each study, and the diamond in the last line represents the pooled estimate and its 95% CI (width of diamond).

Figure 7.

Forest plot and pooled analysis of mean difference in the length of hospital stay between robotic and laparoscopic approaches. The mean difference in the length of hospital stay is reported for each study (black square) along with its 95% confidence interval (CI) (horizontal lines). The size of the square represents the weighted contribution of each study, and the diamond in the last line represents the pooled estimate and its 95% CI (width of diamond).

Figure 8.

Forest plot and pooled analysis of odds ratio for conversion to laparotomy between robotic and laparoscopic approaches. The odds ratio for conversion to laparotomy is reported for each study (black square) along with its 95% confidence interval (CI) (horizontal lines). The size of the square represents the weighted contribution of each study, and the diamond in the last line represents the pooled estimate and its 95% CI (width of diamond).

Figure 9.

Forest plot and pooled analysis of odds ratio for hospital readmission between robotic and laparoscopic approaches. The odds ratio for hospital readmission is reported for each study (black square) along with its 95% confidence interval (CI) (horizontal lines). The size of the square represents the weighted contribution of each study, and the diamond in the last line represents the pooled estimate and its 95% CI (width of diamond).

Figure 10.

Forest plot and pooled analysis of odds ratio for total overall complications between robotic and laparoscopic approaches. The odds ratio for total overall complications is reported for each study (black square) along with its 95% confidence interval (CI) (horizontal lines). The size of the square represents the weighted contribution of each study, and the diamond in the last line represents the pooled estimate and its 95% CI (width of diamond).