Robot-assisted versus laparoscopic-assisted surgery for colorectal cancer: a meta-analysis

Zhang, Xuan; Wei, Zheng-Qiang; Bie, Mengjun; Peng, Xudong; Chen, Cheng

doi:10.1007/s00464-016-4892-z

Cited by 80 publications

(44 citation statements)

References 64 publications

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“…One of the most updated meta-analyses that reviewed 24 studies between January 2010 and October 2015 concluded that the conversion rates, estimated blood loss, and length of hospital stay were significantly lower in robotic surgery. 20 The operative times and total costs were similar to laparoscopy, and there was no significant difference in complication rates and oncological outcomes. The publications by Xiong et al and Wang et al reported superior oncological outcomes in favor of robotics, with CRM positivity rates of 2.74% versus 5.78% for robotics and laparoscopy, respectively.…”

Section: Use Of the XI In Tmementioning

confidence: 74%

“…19 Of the 24 studies included in the meta-analysis by Zhang et al, 17 were retrospective, and only the two by Jiménez-Rodríguez et al and Park et al were randomized trials. [20][21][22] All seven articles in the 2014 publication by Xu et al were included in a 2015 publication by Chang et al, and some of these articles also contributed to half of the meta-analysis by Zarak et al 11,12,[22][23][24][25][26] Between 2014 and 2016, three different journals separately published meta-analyses on robotic versus laparoscopic rectal cancer surgery -all included the same eight studies and 1229 patients. [27][28][29] Two of these publications were authored by the same group.…”

mentioning

confidence: 99%

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The da Vinci Xi: a review of its capabilities, versatility, and potential role in robotic colorectal surgery

Ngu¹,

Tsang²,

Koh³

2017

RSRR

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Abstract:The Xi is the latest da Vinci surgical system approved for use in colorectal surgery. With its novel overhead architecture, slimmer boom-mounted arms, extended instrument reach, guided targeting, and integrated auxiliary technology, the Xi manages to address several limitations of earlier models. The versatility of this new system allows it to be implemented in a wide range of colorectal procedures -from complex multiquadrant colectomies to challenging mesorectal dissections in the pelvis. While commonly criticized for its cost and prolonged operative time, robotic colorectal surgery holds the potential for enhanced ergonomics, superior precision, and a reduction in the learning curve involved in training an expert surgeon. This review appraises the existing literature on robotic colorectal surgery while elaborating how the improved capabilities of the Xi serve to usher in a new era of minimally invasive colorectal surgery.

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Section: Use Of the XI In Tmementioning

confidence: 74%

mentioning

confidence: 99%

The da Vinci Xi: a review of its capabilities, versatility, and potential role in robotic colorectal surgery

Ngu¹,

Tsang²,

Koh³

2017

RSRR

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“…Robotic surgery for colorectal cancer has been widely accepted over the past decade. High-quality evidence such as RCTs and meta-analysis has suggested that robotic surgery can achieve oncological safety compared to laparoscopy with lower conversion rate and faster recovery [ 23 , 24 ]. However, it is still not well explored whether the advantages of robotic surgery can translate into better urogenital function after the procedure.…”

Section: Discussionmentioning

confidence: 99%

Robotic versus laparoscopic surgery for rectal cancer in male urogenital function preservation, a meta-analysis

Tang

Wang

et al. 2018

World J Surg Onc

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BackgroundUrogenital dysfunction after rectal cancer surgery can largely affect patients’ postoperative quality of life. Whether robotic surgery can be a better option when comparing with laparoscopic surgery is still not well-known.MethodsComprehensive search in PubMed, Embase, Cochrane Library, and Clinical Trials was conducted to identify relevant studies in March 2018. Studies comparing robotic surgery with laparoscopic surgery were included. Measurement of urogenital function was through the International Prostate Symptom Score and International Index of Erectile Function.ResultsSix studies with 386 patients in robotic group and 421 patients in laparoscopic group were finally included. Pooled analysis indicated that bladder function was better at 12 months in the robotic group after the procedures (mean difference, − 0.30, 95% CI, − 0.52 to − 0.08). No significant difference was found at 3 and 6 months postoperatively (mean difference, − 0.37, 95% CI, − 1.48 to 0.73; mean difference, − 1.21, 95% CI, − 2.69 to 0.28). Sexual function was better at 3 months in the robotic group after surgery (mean difference, − 3.28, 95% CI, − 6.08 to − 0.49) and not significantly different at 6 and 12 months. (mean difference, 3.78, 95% CI, − 7.37 to 14.93; mean difference, − 2.82, 95% CI, − 8.43 to 2.80).ConclusionRobotic surgery may offer faster recovery in urogenital function compared to laparoscopic surgery for rectal cancer.

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“…Another meta-analysis assessed 24 studies, including two RCTs, with 3318 patients, compared robotic versus laparoscopic surgery for colorectal cancer. 28 The robotic group had significantly lower rates of conversion. There was no difference in postoperative complication rates, distal resection margins, or costs.…”

Section: Robotic Anastomosis After Right Colectomymentioning

confidence: 95%

Appraisal and Current Considerations of Robotics in Colon and Rectal Surgery

Andolfi

Umanskiy

2019

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Background: Robotic technology aims to obviate some of the limitations of conventional laparoscopic surgery, yet the role of robotics in colorectal surgery is still largely undefined and varies with respect to its application in abdominal versus pelvic surgery. Methods: With this review, we aimed to highlight current developments in colorectal robotic surgery. We systematically searched the following databases: PubMed, EMBASE, and Cochrane Library. We critically reviewed the available literature on the use of robotic technology in colon and rectal surgery. Results: Robotic colorectal surgery is oncologically safe and has short-term outcomes comparable to conventional laparoscopy, with potential benefits in rectal surgery. It has a shorter learning curve but increased operative times and costs. It offers potential advantages in the resection of rectal cancer, due to lower conversion rates. There is also a trend toward better outcomes in anastomotic leak rates, circumferential margin positivity, and perseveration of autonomic function. Conclusion: Laparoscopy remains technically challenging and conversion rates are still high. Therefore, most cases of colorectal surgery are still performed open. Robotic surgery aims to overcome the limits of the laparoscopic technique. This new technology has many advantages in terms of articulating instruments, advanced three-dimensional optics, surgeon ergonomics, and improved accessibility to narrow spaces, such as the pelvis. However, further studies are needed to assess long-term results and benefits.The first report on laparoscopic right colectomy was published by Jacobs et al. 1 ; shortly following that Fowler performed the first laparoscopic left colectomy. Since these initial reports, several large studies found that the oncologic outcomes of laparoscopic colectomy were equivalent to open surgery. Despite the growing evidence supporting the use of laparoscopic colectomy for colon cancer, the adoption of this technique was relatively slow due to some limitations: loss of stereoscopic vision and depth perception, paradoxical motion of the instruments, amplified movements, parallel instrumentation, and suboptimal ergonomics. To overcome these shortfalls, the use of hand-assisted laparoscopy was introduced as a bridge between open and laparoscopic surgery. 2,3 Robotic colectomy was first reported in 2002 and since that time adoption of robotic surgery has steadily increased, as evidenced by the number of publications in both medical and lay press. The da Vinci robotic system, the only currently available robotic system in the market approved by the FDA for colorectal surgery, provides several advantages over traditional laparoscopic surgery including a stable camera platform, threedimensional (3D) imaging, improved ergonomics, tremor elimination, ambidextrous capability, motion scaling, and

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Robot-assisted versus laparoscopic-assisted surgery for colorectal cancer: a meta-analysis

Cited by 80 publications

References 64 publications

The da Vinci Xi: a review of its capabilities, versatility, and potential role in robotic colorectal surgery

The da Vinci Xi: a review of its capabilities, versatility, and potential role in robotic colorectal surgery

Robotic versus laparoscopic surgery for rectal cancer in male urogenital function preservation, a meta-analysis

Appraisal and Current Considerations of Robotics in Colon and Rectal Surgery

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