Application of robotic surgery and traditional laparoscopic surgery in lymph node dissection for gynecological cancer: A meta‑analysis

Abstract

Since the advantages of robotic surgery and laparoscopic surgery in the number of lymph node resections are not well understood, this meta-analysis used evidence-based medicine to assess the difference in the number of lymph nodes retrieved in gynecological cancer between the two surgical methods to guide clinical treatment. In the present meta-analysis, the Pubmed, Embase, Cochrane, China National Knowledge Infrastructure and Wanfang libraries were searched for articles that were published from the time of the database's inception to January 2021, including cohort studies and randomized controlled trials, where the observation group underwent robotic surgery to treat gynecological cancers and the control group underwent laparoscopic surgery to treat gynecological cancers, including cervical and ovarian cancers and endometrial cancers. Duplicate publications, studies with no full text, incomplete information or where the authors were unable to perform data extraction, animal experiments, reviews and systematic reviews were excluded. STATA 15.1 was used to analyze the data. Robotic surgery resulted in a significant increase in the number of lymph nodes retrieved from the pelvis [standard mean difference (SMD)=0.24; 95% CI, 0.04-0.45; P=0.007] and para-aortic (SMD=0.41; 95% CI, 0.13-0.69; P=0.004) regions compared with the number retrieved by laparoscopic surgery. Furthermore, there was no significant difference in operating time between robotic and laparoscopic surgery, despite the use of different instruments (SMD=0.12; 95% CI, -0.35-0.58; P=0.616). The amount of blood lost during robotic surgery was significantly less compared with that lost during laparoscopic surgery [SMD=-0.40; 95% CI, -0.58-(-0.22); P<0.001]. The present study evaluated cancer recurrence and death in further detail, and no statistically significant difference was demonstrated between robotic surgery and laparoscopic surgery in terms of recurrence rate [odds ratio (OR)=0.59; 95% CI, 0.21-1.65; P=0.318] and mortality rate (OR=0.31; 95% CI, 0.08-1.30; P=0.109). The present study demonstrated that robotic surgery was able to retrieve more pelvic and para-aortic lymph nodes than traditional laparoscopic surgery, which was consistent with previous reports. With regards to blood loss, The difference in operation time between the two surgical methods was not statistically significant, whereas the estimated blood loss of robotic surgery was significantly lower than that of traditional laparoscopic surgery. There was no statistically significant difference in the recurrence rate and mortality rate of the two surgical modality.

Efficacy and safety of robotic radical hysterectomy in cervical cancer compared with laparoscopic radical hysterectomy: a meta-analysis

“…Our findings suggest that RRH is superior than LRH in terms of the number of pelvic lymph nodes dissected. Prior research has also indicated that robotic surgery yields superior results in lymph node dissection for gynecological cancer compared to traditional laparoscopic surgery ( 25 , 26 ). This is due to the improved clarity and balance of RRH, as well as the capability of its endoscopic operating device to replicate the movement of the human wrist.…”

The emerging roles of long non-coding RNA (lncRNA) H19 in gynecologic cancers

“…To evaluate the size and metastasis of GCs, imaging modalities such as ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) scans are routinely employed [ 11 ]. Also, various biopsy techniques, including colposcopy [ 12 ], endometrial biopsy [ 13 ], hysteroscopy [ 14 ], and laparoscopy [ 15 ], are utilized to procure tissue samples from suspected tumors or abnormal regions for further analysis and confirmation. Molecular tests can identify specific biomarkers associated with GCs, such as human papillomavirus (HPV) testing for cervical cancer or genetic testing for ovarian cancer [ 16 , 17 ].…”