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Meta-Analysis
. 2021 Apr 30;100(17):e25648.
doi: 10.1097/MD.0000000000025648.

Robot-assisted versus laparoscopic minor hepatectomy: A systematic review and meta-analysis

Ji-Ming Wang  1 , Jiang-Fa Li, Guan-Dou Yuan, Song-Qing He
Affiliations
Meta-Analysis

Robot-assisted versus laparoscopic minor hepatectomy: A systematic review and meta-analysis

Ji-Ming Wang et al. Medicine (Baltimore). .

Abstract

Background: Robot-assisted and laparoscopic surgery are the most minimally invasive surgical approaches for the removal of liver lesions. Minor hepatectomy is a common surgical procedure. In this study, we evaluated the advantages and disadvantages of robot-assisted vs laparoscopic minor hepatectomy (LMH).

Methods: A systematic literature search was performed in PubMed, Embase, and the Cochrane Library to identify comparative studies on robot-assisted vs. laparoscopicminor hepatectomy up to February, 2020. The odds ratios (OR) and mean differences with 95% confidence intervals were calculated using the fixed-effects model or random-effects model.

Results: A total of 12 studies involving 751 patients were included in the meta-analysis. Among them, 297 patients were in the robot-assisted minor hepatectomy (RMH) group and 454 patients were in the LMH group. There were no significant differences in intraoperative blood loss (P = .43), transfusion rates (P = .14), length of hospital stay (P > .64), conversion rate (P = .62), R0 resection rate (P = .56), complications (P = .92), or mortaliy (P = .37) between the 2 groups. However, the RMH group was associated with a longer operative time (P = .0003), and higher cost (P < .00001) compared to the LMH group. No significant differences in overall survival or disease free survival between the 2 groups were observed. In the subgroup analysis of left lateral sectionectomies, RMH was still associated with a longer operative time, but no other differences in clinical outcomes were observed.

Conclusions: Although RMH is associated with longer operation times and higher costs, it exhibits the same safety and effectiveness as LMH. Prospective randomized controlled clinical trials should now be considered to obtain better evidence for clinical consensus.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flow chart of the literature selection.
Figure 2
Figure 2
Forest plot of meta-analysis concerning operative time.
Figure 3
Figure 3
Forest plot of meta-analysis concerning blood loss.
Figure 4
Figure 4
Forest plot of meta-analysis concerning transfusion rate.
Figure 5
Figure 5
Forest plot of meta-analysis concerning conversion rate.
Figure 6
Figure 6
Forest plot of meta-analysis concerning R0 resection rate.
Figure 7
Figure 7
Forest plot of meta-analysis concerning overall complication rate.
Figure 8
Figure 8
Forest plot of meta-analysis concerning minor complication rate.
Figure 9
Figure 9
Forest plot of meta-analysis concerning major complication rate.
Figure 10
Figure 10
Forest plot of meta-analysis concerning hospital stay.
Figure 11
Figure 11
Meta-analysis Forest plot of postoperative mortality.
Figure 12
Figure 12
Funnel plot of the overall complication rates included in the studies.
See this image and copyright information in PMC

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