Robot-assisted laparoscopic surgery versus conventional laparoscopic surgery in randomized controlled trials: A systematic review and meta-analysis

Abstract

Importance: This review provides a comprehensive comparison of treatment outcomes between robot-assisted laparoscopic surgery (RLS) and conventional laparoscopic surgery (CLS) based on randomly-controlled trials (RCTs).

Objectives: We employed RCTs to provide a systematic review that will enable the relevant community to weigh the effectiveness and efficacy of surgical robotics in controversial fields on surgical procedures both overall and on each individual surgical procedure.

Evidence review: A search was conducted for RCTs in PubMed, EMBASE, and Cochrane databases from 1981 to 2016. Among a total of 1,517 articles, 27 clinical reports with a mean sample size of 65 patients per report (32.7 patients who underwent RLS and 32.5 who underwent CLS), met the inclusion criteria.

Findings: CLS shows significant advantages in total operative time, net operative time, total complication rate, and operative cost (p < 0.05 in all cases), whereas the estimated blood loss was less in RLS (p < 0.05). As subgroup analyses, conversion rate on colectomy and length of hospital stay on hysterectomy statistically favors RLS (p < 0.05).

Conclusions: Despite higher operative cost, RLS does not result in statistically better treatment outcomes, with the exception of lower estimated blood loss. Operative time and total complication rate are significantly more favorable with CLS.

Fig 1. Schematic representation of the study selection process.

This study attempted to screen leniently and perform a full-text search whenever possible in order to more confidently determine whether to include or exclude studies and extract information necessary for meta-analysis [50].

Fig 2. Risk of bias assessments.

Bias assessments of RCTs were performed in terms of random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective reporting, and other biases. +, -, and a blank space denote lower risk, high risk, and unclear risk, respectively, for the risk judgement.

Fig 3. Forest plots with subgroups.

Comparison of RLS and CLS with respect to (A) total operative time, (B) net operative time, (C) total operative cost, (D) estimated blood loss, (E) blood transfusion, (F) length of hospital stay, (G) conversion, (H) total complication, (I) intra-operative complication, and (J) post-operative complication. Note that, although Cochrane RevMan reports “Not estimable” for the study whose value include “0” value and does not take the study into account for the forest-plot analysis, the present study reports all available values from the studies for completeness. OR: odds ratio; WMD: weighted mean difference.