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Abstract：
UNASSIGNED: Robotic surgery has been progressively implemented for colorectal procedures but is still limited for multiquadrant abdominal resections. The present study aims to describe our experience in robotic multiquadrant colorectal surgeries and provide a systematic review and meta-analysis of the literature investigating the outcomes of robotic total proctocolectomy (TPC), total colectomy (TC), subtotal colectomy (STC), or completion proctectomy (CP) compared to laparoscopy.
UNASSIGNED: At our institution 16 consecutive patients underwent a 2- or 3-stage totally robotic total proctocolectomy (TPC) with ileal pouch-anal anastomosis. A systematic review of the literature was performed to select studies on robotic and laparoscopic multiquadrant colorectal procedures. Meta-analyses were used to compare the two approaches.
UNASSIGNED: In our case series, 14/16 patients underwent a 2-stage robotic TPC for ulcerative colitis with a mean operative time of 271.42 (SD:37.95) minutes. No conversion occurred. Two patients developed postoperative complications. The mean hospital stay was 8.28 (SD:1.47) days with no readmissions. Mortality was nil. All patients underwent loop-ileostomy closure, and functional outcomes were satisfactory. The literature appraisal was based on 23 retrospective studies, including 736 robotic and 9,904 laparoscopic multiquadrant surgeries. In the robotic group, 36 patients underwent STC, 371 TC, 166 TPC, and 163 CP. Pooled data analysis showed that robotic TC and STC had a lower conversion rate (OR = 0.17;95% CI, 0.04-0.82; p = 0.03) than laparoscopic TC and STC. The robotic approach was associated with longer operative time for TC and STC (MD = 104.64;95% CI, 18.42-190.87; p = 0.02) and TPC and CP (MD = 38.8;95% CI, 18.7-59.06; p = 0.0002), with no differences for postoperative complications and hospital stay. Reports on urological outcomes, sexual dysfunction, and quality of life were missing.
UNASSIGNED: Our experience and the literature suggest that robotic multiquadrant colorectal surgery is safe and effective, with low morbidity and mortality rates. Nevertheless, the overall level of evidence is low, and functional outcomes of robotic approach remain largely unknown.
UNASSIGNED: https://www.crd.york.ac.uk/prospero/, identifier: CRD42022303016.
UNASSIGNED: At our institution 16 consecutive patients underwent a 2- or 3-stage totally robotic total proctocolectomy (TPC) with ileal pouch-anal anastomosis. A systematic review of the literature was performed to select studies on robotic and laparoscopic multiquadrant colorectal procedures. Meta-analyses were used to compare the two approaches.
UNASSIGNED: In our case series, 14/16 patients underwent a 2-stage robotic TPC for ulcerative colitis with a mean operative time of 271.42 (SD:37.95) minutes. No conversion occurred. Two patients developed postoperative complications. The mean hospital stay was 8.28 (SD:1.47) days with no readmissions. Mortality was nil. All patients underwent loop-ileostomy closure, and functional outcomes were satisfactory. The literature appraisal was based on 23 retrospective studies, including 736 robotic and 9,904 laparoscopic multiquadrant surgeries. In the robotic group, 36 patients underwent STC, 371 TC, 166 TPC, and 163 CP. Pooled data analysis showed that robotic TC and STC had a lower conversion rate (OR = 0.17;95% CI, 0.04-0.82; p = 0.03) than laparoscopic TC and STC. The robotic approach was associated with longer operative time for TC and STC (MD = 104.64;95% CI, 18.42-190.87; p = 0.02) and TPC and CP (MD = 38.8;95% CI, 18.7-59.06; p = 0.0002), with no differences for postoperative complications and hospital stay. Reports on urological outcomes, sexual dysfunction, and quality of life were missing.
UNASSIGNED: Our experience and the literature suggest that robotic multiquadrant colorectal surgery is safe and effective, with low morbidity and mortality rates. Nevertheless, the overall level of evidence is low, and functional outcomes of robotic approach remain largely unknown.
UNASSIGNED: https://www.crd.york.ac.uk/prospero/, identifier: CRD42022303016.
摘要：
未经授权：机器人手术已逐步用于结直肠手术，但仍限于多象限腹部切除。本研究旨在描述我们在机器人多象限结直肠手术中的经验，并对研究机器人全结直肠切除术（TPC）结果的文献进行系统回顾和荟萃分析。全结肠切除术（TC），结肠次全切除术（STC），或完成直肠切除术（CP）与腹腔镜检查相比。
UNASSIGNED：在我们机构中，连续16例患者接受了2或3期完全机器人全直肠结肠切除术（TPC），并进行回肠袋-肛门吻合术。对文献进行了系统回顾，以选择有关机器人和腹腔镜多象限结直肠手术的研究。采用Meta分析比较两种方法。
UNASSIGNED：在我们的案例系列中，14/16例患者接受了2期机器人TPC治疗溃疡性结肠炎，平均手术时间为271.42（SD：37.95）分钟。未发生转换。两名患者出现术后并发症。平均住院时间为8.28（SD：1.47）天，无再入院。死亡率为零。所有患者均接受回肠环造口术闭合，功能结果令人满意。文献评估基于23项回顾性研究，包括736个机器人和9,904个腹腔镜多象限手术。在机器人组中，36例患者接受STC，371TC,166TPC,163CP。汇总数据分析显示，机器人TC和STC的转换率（OR=0.17；95％CI，0.04-0.82；p=0.03）低于腹腔镜TC和STC。机器人入路与TC和STC（MD=104.64；95％CI，18.42-190.87；p=0.02）以及TPC和CP（MD=38.8；95％CI，18.7-59.06；p=0.0002）的手术时间更长，术后并发症和住院时间无差异。关于泌尿外科结果的报告，性功能障碍,生活质量缺失。
UNASSIGNED：我们的经验和文献表明，机器人多象限结直肠手术是安全有效的，低发病率和死亡率。然而，证据的总体水平很低，机器人方法的功能结果在很大程度上仍然未知。
UNASSIGNED：https://www。crd.约克。AC.英国/普华永道/，标识符：CRD42022303016。
UNASSIGNED：在我们机构中，连续16例患者接受了2或3期完全机器人全直肠结肠切除术（TPC），并进行回肠袋-肛门吻合术。对文献进行了系统回顾，以选择有关机器人和腹腔镜多象限结直肠手术的研究。采用Meta分析比较两种方法。
UNASSIGNED：在我们的案例系列中，14/16例患者接受了2期机器人TPC治疗溃疡性结肠炎，平均手术时间为271.42（SD：37.95）分钟。未发生转换。两名患者出现术后并发症。平均住院时间为8.28（SD：1.47）天，无再入院。死亡率为零。所有患者均接受回肠环造口术闭合，功能结果令人满意。文献评估基于23项回顾性研究，包括736个机器人和9,904个腹腔镜多象限手术。在机器人组中，36例患者接受STC，371TC,166TPC,163CP。汇总数据分析显示，机器人TC和STC的转换率（OR=0.17；95％CI，0.04-0.82；p=0.03）低于腹腔镜TC和STC。机器人入路与TC和STC（MD=104.64；95％CI，18.42-190.87；p=0.02）以及TPC和CP（MD=38.8；95％CI，18.7-59.06；p=0.0002）的手术时间更长，术后并发症和住院时间无差异。关于泌尿外科结果的报告，性功能障碍,生活质量缺失。
UNASSIGNED：我们的经验和文献表明，机器人多象限结直肠手术是安全有效的，低发病率和死亡率。然而，证据的总体水平很低，机器人方法的功能结果在很大程度上仍然未知。
UNASSIGNED：https://www。crd.约克。AC.英国/普华永道/，标识符：CRD42022303016。
