正中弓状韧带综合征(MALS)是罕见的综合征,是排除性诊断。尽管在2007年首次描述了机器人正中弓状韧带释放(MALR),但只有少数病例报告(CR)。案例系列(CS),和已发表文献中的回顾性队列研究(RCS)。这项研究的目的是评估机器人辅助MALR(r-MALR)的可行性和安全性。PubMed,Embase,并在Cochrane数据库中搜索了报告r-MALR的文章(最后一次搜索2023年12月)。所有研究包括CR,CS,RCS报告技术可行性(操作时间和转换率),安全性(术中并发症,失血,术后并发症),结果(住院时间[LoS])包括在内(PROSPERO:CRD42024502792)。共有23项研究(8-CR,5-CS,10-RCS),共有290例患者可在文献中获得。除了1-RCS,所有研究报告的CR年龄和平均年龄为40.38±17.7,CS为36.08±15.12,RS为39.72±7.35年;除2-RCS外,所有研究均报告了性别分布,男性57例,女性214例.工作时间:3-CR,4-CS,9-RCS报告的运行时间,平均时间为111±54、131.69±7.51、117.34±35.03分钟,分别。转换率:所有研究都报告了有关转换的数据,只有4例(1.37%)病例转换为腹腔镜方法,三至开放入路(1-意外腹腔动脉切开术,2-未提及的原因)。术中并发症:仅5-CR,4-CS,9-RCS报告了术中并发症的数据,只有6种并发症(1.5%):1-无意的腹腔动脉切开术转换为开放;3-未命名的血管损伤(2例通过机器人管理,1转换为开放);1例通过机器人管理出血;没有其他报告的伤害。估计失血量为5至30ml。术后并发症:5-CR,4-CS,8-RCS描述了21例(7%)患者的术后并发症。20例一级,一个是IIIa级,并且都成功管理。LoS住宿:2-CR,4-CS,10-RCS报告了LoS和总体,已经两天了。r-MALR是合理的,技术上可行,安全,并有可接受的结果。此外,机器人方法提供了卓越的视野,提高灵活性,精确,和容易的圆周解剖。PROSPERO注册:该协议已在PROSPERO数据库(CRD42024502792)中注册。
Median arcuate ligament syndrome (MALS) is rare syndrome and is diagnosis of exclusion. Though first robotic median arcuate ligament release (MALR) was described in 2007, there are only a few case reports (CR), case series (CS), and retrospective cohort studies (RCS) in the published literature. The purpose of this study was to assess the feasibility and safety of robotic-assisted MALR (r-MALR). PubMed, Embase, and Cochrane databases were searched (last search December 2023) for articles reporting r-MALR. All studies including CR, CS, RCS reporting technical feasibility (operating time and rate of conversions), safety (intra-operative complications, blood loss, post-operative complications), and outcome (length of stay [LoS]) were included (PROSPERO: CRD42024502792). A total of 23 studies (8-CR, 5-CS, 10-RCS) with total 290 patients were available in the literature. Except 1-RCS, all studies reported age and mean age for CR was 40.38 ± 17.7, 36.08 ± 15.12 for CS, 39.72 ± 7.35 years for RS; except 2-RCS, all studies reported gender distribution and there were 57 males and 214 females. Operating time: 3-CR, 4-CS, 9-RCS reported operating time, and mean time was 111 ± 54, 131.69 ± 7.51, 117.34 ± 35.03 min, respectively. Conversion rate: All studies reported data on conversion and only four (1.37%) cases were converted-one to laparoscopic approach, three to open approach (1-inadvertent celiac arteriotomy, 2-reasons not mentioned). Intraoperative complications: only 5-CR, 4-CS, and 9-RCS reported data on intra-operative complications, and there were only 6 complications (1.5%): 1-inadvertent celiac arteriotomy converted to open; 3-unnamed vascular injuries (2 managed robotically, 1 converted to open); 1-bleeding managed robotically; there were no other reported injuries. Estimated blood loss ranged from 5 to 30 ml. Post-operative complications: 5-CR, 4-CS, 8-RCS described post-operative complications in 21 (7%) patients. Twenty cases were grade I, one was grade IIIa, and all managed successfully. LoS stay: 2-CR, 4-CS, 10-RCS reported LoS and overall, it was 2 days. r-MALR is reasonable, technically feasible, safe, and has acceptable outcomes. In addition, robotic approach provided superior vision, improved dexterity, precise, and easy circumferential dissection.PROSPERO registration: The protocol was registered in the PROSPERO database (CRD42024502792).