目的:比较腹横肌松解术(TAR)采用开放式(oTAR)和机器人(rTAR)方法进行腹侧疝修补术后的早期结果。
方法:对PubMed/MEDLINE的系统搜索,EMBASE,在2020年10月之前,进行了SCOPUS和WebofScience数据库以确定比较研究。对术后短期结果进行了荟萃分析,包括并发症发生率,手术时间,逗留时间,手术部位感染(SSI),手术部位发生(SSO),需要干预的SSO(SSOPI),全身性并发症,重新接纳,和再手术率作为衡量结果。
结果:六项回顾性研究纳入分析,共831例患者接受rTAR(n=237)和oTAR(n=594)。机器人TAR与较低的并发症发生率相关(9.3vs20.7%,或0.358,95%CI0.218-0.589,p<0.001),发展SSO的风险较低(5.3对11.5%,OR0.669,95%CI0.307-1.458,p=0.02),发生全身并发症的风险较低(6.3vs26.5%,OR0.208,95%CI0.100-0.433,p<0.001),与oTAR相比,住院时间更短(SMD-4.409,95%CI-6.000至-2.818,p<0.001),但手术时间更长(SMD53.115,95%CI30.236-75.993,p<0.01)。在SSI方面没有统计学上的显著差异,SSOPI,重新接纳,和再操作率。
结论:与开放手术相比,机器人TAR通过增加微创手术的益处来改善恢复。尽管通过机器人方法,术后并发症似乎减少了,需要进一步的研究来支持真正的长期和成本效益优势。
OBJECTIVE: To compare early postoperative outcomes after transversus abdominis release (TAR) for ventral hernia repair with open (oTAR) and robotic (rTAR) approach.
METHODS: A systematic search of PubMed/MEDLINE, EMBASE, SCOPUS and Web of Science databases was conducted to identify comparative studies until October 2020. A meta-analysis of postoperative short-term outcomes was performed including complications rate, operative time, length of stay, surgical site infection (SSI), surgical site occurrence (SSO), SSO requiring intervention (SSOPI), systemic complications, readmission, and reoperation rates as measure outcomes.
RESULTS: Six retrospective studies were included in the analysis with a total of 831 patients who underwent rTAR (n = 237) and oTAR (n = 594). Robotic TAR was associated with lower risk of complications rate (9.3 vs 20.7%, OR 0.358, 95% CI 0.218-0.589, p < 0.001), lower risk of developing SSO (5.3 vs 11.5%, OR 0.669, 95% CI 0.307-1.458, p = 0.02), lower risk of developing systemic complications (6.3 vs 26.5%, OR 0.208, 95% CI 0.100-0.433, p < 0.001), shorter hospital stay (SMD - 4.409, 95% CI - 6.000 to - 2.818, p < 0.001) but longer operative time (SMD 53.115, 95% CI 30.236-75.993, p < 0.01) compared with oTAR. There was no statistically significant difference in terms of SSI, SSOPI, readmission, and reoperation rates.
CONCLUSIONS: Robotic TAR improves recovery by adding the benefits of minimally invasive procedures when compared to open surgery. Although postoperative complications appear to decrease with a robotic approach, further studies are needed to support the real long-term and cost-effective advantages.