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Meta-Analysis
. 2022 Jul;37(7):1497-1507.
doi: 10.1007/s00384-022-04194-8. Epub 2022 Jun 1.

Robotic versus laparoscopic left colectomy: a systematic review and meta-analysis

Leonardo Solaini  1   2 , Antonio Bocchino  3 , Andrea Avanzolini  4 , Domenico Annunziata  4 , Davide Cavaliere  4 , Giorgio Ercolani  3   4
Affiliations
Meta-Analysis

Robotic versus laparoscopic left colectomy: a systematic review and meta-analysis

Leonardo Solaini et al. Int J Colorectal Dis. 2022 Jul.

Abstract

Background: This study aimed to review the new evidence to understand whether the robotic approach could find some clear indication also in left colectomy.

Methods: A systematic review of studies published from 2004 to 2022 in the Web of Science, PubMed, and Scopus databases and comparing laparoscopic (LLC) and robotic left colectomy (RLC) was performed. All comparative studies evaluating robotic left colectomy (RLC) versus laparoscopic (LLC) left colectomy with at least 20 patients in the robotic arm were included. Abstract, editorials, and reviews were excluded. The Newcastle-Ottawa Scale for cohort studies was used to assess the methodological quality. The random-effect model was used to calculate pooled effect estimates.

Results: Among the 139 articles identified, 11 were eligible, with a total of 52,589 patients (RLC, n = 13,506 versus LLC, n = 39,083). The rate of conversion to open surgery was lower for robotic procedures (RR 0.5, 0.5-0.6; p < 0.001). Operative time was longer for the robotic procedures in the pooled analysis (WMD 39.1, 17.3-60.9, p = 0.002). Overall complications (RR 0.9, 0.8-0.9, p < 0.001), anastomotic leaks (RR 0.7, 0.7-0.8; p < 0.001), and superficial wound infection (RR 3.1, 2.8-3.4; p < 0.001) were less common after RLC. There were no significant differences in mortality (RR 1.1; 0.8-1.6, p = 0.124). There were no differences between RLC and LLC with regards to postoperative variables in the subgroup analysis on malignancies.

Conclusions: Robotic left colectomy requires less conversion to open surgery than the standard laparoscopic approach. Postoperative morbidity rates seemed to be lower during RLC, but this was not confirmed in the procedures performed for malignancies.

Keywords: Colorectal surgery; Laparoscopy; Left colectomy; Left hemicolectomy; Robotic surgery.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow chart
Fig. 2
Fig. 2
Forest plots of a operative time, b blood loss, c stoma, and d conversion to open surgery
Fig. 3
Fig. 3
Forest plots of a overall complication, b Clavien-Dindo > 2 complications, c mortality, and d hospital stay
Fig. 4
Fig. 4
Forest plots of a postoperative bleeding, b anastomotic leak, c ileus, and d superficial wound infection
See this image and copyright information in PMC

References

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