PDF(Pubmed)
Abstract：
Introduction: Complicated diverticulitis is a common abdominal emergency that often requires a surgical intervention. The systematic review and meta-analysis below compare the benefits and harms of robotic vs. laparoscopic surgery in patients with complicated colonic diverticular disease. Methods: The following databases were searched before 1 March 2023: Cochrane Library, PubMed, Embase, CINAHL, and ClinicalTrials.gov. The internal validity of the selected non-randomized studies was assessed using the ROBINS-I tool. The meta-analysis and trial sequential analysis were performed using RevMan 5.4 (Cochrane Collaboration, London, United Kingdom) and Copenhagen Trial Unit Trial Sequential Analysis (TSA) software (Copenhagen Trial Unit, Center for Clinical Intervention Research, Rigshospitalet, Copenhagen, Denmark), respectively. Results: We found no relevant randomized controlled trials in the searched databases. Therefore, we analyzed 5 non-randomized studies with satisfactory internal validity and similar designs comprising a total of 442 patients (184 (41.6%) robotic and 258 (58.4%) laparoscopic interventions). The analysis revealed that robotic surgery for complicated diverticulitis (CD) took longer than laparoscopy (MD = 42 min; 95% CI: [-16, 101]). No statistically significant differences were detected between the groups regarding intraoperative blood loss (MD = -9 mL; 95% CI: [-26, 8]) and the rate of conversion to open surgery (2.17% or 4/184 for robotic surgery vs. 6.59% or 17/258 for laparoscopy; RR = 0.63; 95% CI: [0.10, 4.00]). The type of surgery did not affect the length of in-hospital stay (MD = 0.18; 95% CI: [-0.60, 0.97]) or the rate of postoperative complications (14.1% or 26/184 for robotic surgery vs. 19.8% or 51/258 for laparoscopy; RR = 0.81; 95% CI: [0.52, 1.26]). No deaths were reported in either group. Discussion: The meta-analysis suggests that robotic surgery is an appropriate option for managing complicated diverticulitis. It is associated with a trend toward a lower rate of conversion to open surgery and fewer postoperative complications; however, this trend does not reach the level of statistical significance. Since no high quality RCTs were available, this meta-analysis isnot able to provide reliable conclusion, but only a remarkable lack of proper evidence supporting robotic technology. The need for further evidence-based trials is important.
摘要：
简介：复杂性憩室炎是一种常见的腹部急症，通常需要手术干预。下面的系统评价和荟萃分析比较了机器人与机器人的利弊。复杂性结肠憩室病的腹腔镜手术。方法：在2023年3月1日之前搜索了以下数据库：Cochrane图书馆，PubMed,Embase,CINAHL,和ClinicalTrials.gov.使用ROBINS-I工具评估选定的非随机研究的内部有效性。使用RevMan5.4（CochraneCollaboration，伦敦,联合王国)和哥本哈根试验单位试验顺序分析(TSA)软件(哥本哈根试验单位，临床干预研究中心，Rigshospitalet,哥本哈根,Denmark),分别。结果：我们在检索的数据库中没有发现相关的随机对照试验。因此,我们分析了5项非随机研究,其内部效度令人满意,设计相似,共包括442例患者(184例(41.6%)机器人和258例(58.4%)腹腔镜介入).分析显示，复杂憩室炎（CD）的机器人手术比腹腔镜手术花费的时间更长（MD=42分钟；95％CI：[-16，101]）。两组之间在术中失血量（MD=-9mL；95％CI：[-26，8]）和转换为开放手术的比率（机器人手术的2.17％或4/184与腹腔镜检查为6.59%或17/258；RR=0.63；95%CI：[0.10，4.00]）。手术类型不影响住院时间（MD=0.18；95％CI：[-0.60，0.97]）或术后并发症的发生率（机器人手术的14.1%或26/184与腹腔镜检查为19.8%或51/258；RR=0.81；95%CI：[0.52，1.26]）。两组均无死亡报告。讨论：荟萃分析表明，机器人手术是治疗复杂憩室炎的合适选择。它与开放手术的转化率降低和术后并发症减少的趋势有关；然而，这一趋势没有达到统计学意义的水平。由于没有高质量的RCT，这种荟萃分析不能提供可靠的结论，但只是缺乏支持机器人技术的适当证据。需要进一步的循证试验非常重要。
