Comparative clinical outcomes of robot-assisted liver resection versus laparoscopic liver resection: A meta-analysis.
Comparative clinical outcomes of robot-assisted liver resection versus laparoscopic liver resection: A meta-analysis.
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DOI：
10.1371/journal.pone.0240593
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发表时间：
2020
期刊：
影响因子：
3.7
通讯作者：
Wang W
中科院分区：
文献类型：
--
作者：
Zhang L;Yuan Q;Xu Y;Wang W
机器人辅助手术系统作为一种新兴技术，在许多复杂的内窥镜手术中具有潜在的优势。但机器人辅助肝切除术与腹腔镜肝切除术相比，其优势仍存在争议。我们的目的是进行荟萃分析，以评估和比较机器人辅助和腹腔镜肝切除术的临床结局。我们检索了截至2020年3月24日的PubMed、科克伦图书馆、Embase数据库、临床试验和Opengrey，包括合格文章的参考文献。纳入了关于机器人辅助和腹腔镜肝切除术的英语原始人类研究。标题、摘要和文章由至少2名独立读者审查。连续变量和二分变量分别用加权平均差（WMD）和比值比（OR）进行比较。在我们最初检索的936篇文章中，28篇符合我们的标准，涉及3544例患者。与腹腔镜相比，机器人辅助组的手术时间更长（WMD：36.93; 95%CI，19.74-54.12; P < 0.001），转化率低（OR：0.63; 95% CI，0.46-0.87; P = 0.005），输血率高（WMD：2.39; 95% CI，1.51-3.76; P < 0.001），总费用高（WMD：0.49; 95% CI，0.42-0.55; P < 0.001）。此外，机器人辅助与腹腔镜肝切除术相比，患者最大肿瘤大小的基线特征更大（WMD：0.36; 95%CI，0.16-0.56; P < 0.001），恶性病变率更高（WMD：1.50; 95%CI，1.21-1.86; P < 0.001）。小肝切除术的亚组分析显示，机器人辅助与手术时间延长相关（WMD：36.00; 95%CI，12.59-59.41; P = 0.003），住院时间较长（WMD：0.51; 95% CI，0.02-1.01; p = 0.04）和更高的总成本（WMD：0.48; 95% CI，0.25-0.72; P < 0.001）（表3）;而肝大部切除术的亚组分析显示，机器人辅助与估计失血量较低相关（大规模毁灭性武器：-122.43; 95%CI为-151.78--93.08; P < 0.001）。我们的荟萃分析显示，机器人辅助与手术时间较长、中转率较低、输血率较高和总费用较高相关，与腹腔镜肝切除术相比，机器人辅助在肝大部切除术中具有一定的优势。
As an emerging technology, robot-assisted surgical system has some potential merits in many complicated endoscopic procedures compared with laparoscopic surgery. But robot-assisted liver resection is still a controversial problem on its advantages compared with laparoscopic liver resection. We aimed to perform the meta-analysis to assess and compare the clinical outcomes of robot-assisted and laparoscopic liver resection. We searched PubMed, Cochrane Library, Embase databases, Clinicaltrials, and Opengrey through March 24, 2020, including references of qualifying articles. English-language, original investigations in humans about robot-assisted and laparoscopic hepatectomy were included. Titles, abstracts, and articles were reviewed by at least 2 independent readers. Continuous and dichotomous variables were compared by the weighted mean difference (WMD) and odds ratio (OR), respectively. Of 936 titles identified in our original search, 28 articles met our criteria, involving 3544 patients. Compared with laparoscopy, the robot-assisted groups had longer operative time (WMD: 36.93; 95% CI, 19.74–54.12; P < 0.001), lower conversion rate (OR: 0.63; 95% CI, 0.46–0.87; P = 0.005), higher transfusion rate (WMD: 2.39; 95% CI, 1.51–3.76; P < 0.001) and higher total cost (WMD:0.49; 95% CI, 0.42–0.55; P < 0.001). In addition, the baseline characteristics of patients about largest tumor size was larger (WMD: 0.36; 95% CI, 0.16–0.56; P < 0.001) and malignant lesions rate was higher (WMD: 1.50; 95% CI, 1.21–1.86; P < 0.001) in the robot-assisted versus laparoscopic hepatectomy. The subgroup analysis of minor hepatectomy showed robot-assisted was associated with longer operative time (WMD: 36.00; 95% CI, 12.59–59.41; P = 0.003), longer length of stay (WMD: 0.51; 95% CI, 0.02–1.01; p = 0.04) and higher total cost (WMD: 0.48; 95% CI, 0.25–0.72; P < 0.001) (Table 3); while the subgroup analysis of major hepatectomy showed robot-assisted was associated with lower estimated blood loss (WMD: -122.43; 95% CI, -151.78–-93.08; P < 0.001). Our meta-analysis revealed that robot-assisted was associated with longer operative time, lower conversion rate, higher transfusion rate and total cost, and robot-assisted has certain advantages in major hepatectomy compared with laparoscopic hepatectomy.
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DOI：
10.1007/s00464-019-06976-8
发表时间：
2020-05-01
影响因子：
3.1
作者：
Chong, Charing C. N.;Lok, H. T.;Lai, Paul B. S.
通讯作者：
Lai, Paul B. S.
影响因子：
9
作者：
Ji, Wen-bin;Wang, Hong-guang;Dong, Jia-hong
通讯作者：
Dong, Jia-hong
影响因子：
4.3
作者：
Hu, Ben-Shun;Chen, Ke;Tan, Jing-Wang
通讯作者：
Tan, Jing-Wang
影响因子：
2.3
作者：
Croner, Roland S.;Perrakis, Aristotiles;Brunner, Maximillian
通讯作者：
Brunner, Maximillian
影响因子：
3.7
作者：
Liu L;Wang Z;Jiang S;Shao B;Liu J;Zhang S;Zhou Y;Zhou Y;Zhang Y
通讯作者：
Zhang Y