METHODS: A comprehensive literature review was conducted including Medline/PubMed, Embase, and Scopus (PROSPERO registration number CRD 42022344764) through October 2022. The systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The risk of bias was evaluated using the ROBINS-I tool. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines and GRADEpro to develop a summary of evidence tables. Random-effects meta-analyses were conducted.
RESULTS: Five observational retrospective studies (496 patients, 275 2D and 216 3D) were included. One study was rated as having a critical risk of bias; the remaining had low to moderate risk. 2D laparoscopic right hemicolectomy patients showed longer anastomotic time in 3/3 studies (MD = 3.32; 95%CI, 1.58-5.05; p = 0.002) and an upward trend in operative time in 4/5 studies (MD = 9.98; 95%CI, -1.42, 21.37; p = 0.086) compared to 3D. The two image video systems had similar short-term outcomes, including the number of lymph nodes harvested (MD = -0.67; 95%CI, -2.47, 1.13; p = 0.47), morbidity (OR post-operative complications = 1.12; 95%CI, 0.71-1.77; p = 0.62), and length of stay (MD = 0.27; 95%CI, -0.59, 1.13; p = 0.9).
CONCLUSIONS: 2D and 2D laparoscopic right hemicolectomy had similar complications rate, with a shorter anastomotic time along with a downward trend in overall operative time for 3D. Larger prospective randomized trials are awaited before definitive conclusions can be drawn.
方法:进行了全面的文献综述,包括Medline/PubMed,Embase,和Scopus(PROSPERO注册号CRD42022344764)至2022年10月。根据系统评价和荟萃分析(PRISMA)指南的首选报告项目进行系统评价和荟萃分析。使用ROBINS-I工具评估偏倚风险。使用建议分级评估来评估证据的确定性,发展,和评估(GRADE)指南和GRADEPro制定证据表摘要。进行随机效应荟萃分析。
结果:五项观察性回顾性研究(496例患者,包括2752D和2163D)。一项研究被认为具有严重的偏倚风险;其余的风险为低至中等。与3D相比,2D腹腔镜右半结肠切除术患者在3/3研究中吻合时间更长(MD=3.32;95CI,1.58-5.05;p=0.002),在4/5研究中手术时间呈上升趋势(MD=9.98;95CI,-1.42,21.37;p=0.086)。两种图像视频系统的短期结果相似,包括收集的淋巴结数量(MD=-0.67;95CI,-2.47,1.13;p=0.47),发病率(OR术后并发症=1.12;95CI,0.71-1.77;p=0.62),和住院时间(MD=0.27;95CI,-0.59,1.13;p=0.9)。
结论:2D和2D腹腔镜右半结肠切除术的并发症发生率相似,吻合时间较短,3D的总体手术时间呈下降趋势。在得出明确的结论之前,等待更大的前瞻性随机试验。