背景:在外科手术方面,机器人辅助手术(RAS)有几个承诺,如缩短住院时间,减少并发症,与标准护理相比,技术能力得到了提高。尽管有大量证据,RAS对患者的实际获益尚不清楚.因此,我们的系统评价旨在评估RAS在内脏和胸部手术中与腹腔镜或开腹手术相比的有效性和安全性.
方法:我们于2023年4月在两个数据库(MedlineviaOvid和TheCochraneLibrary)中进行了系统的文献检索。搜索仅限于14个预定义的胸部和内脏手术和随机对照试验(RCTs)。在对建议进行分级之后,对关键成果的数据进行了综合,评估,发展,和评估方法,使用Cochrane协作工具第1版评估偏倚风险。
结果:对于14个程序中的5个,没有证据可以确定。共有20个RCT和5个随访出版物符合纳入标准。总的来说,大多数研究未报告或测量患者相关终点.大多数结果显示研究组之间具有可比性。然而,RAS在特定终点显示出潜在的优势(例如,失血),然而,这些发现依赖于数量有限的低质量研究.在某些适应症复发的某些结果中,还注意到统计学上显着的RAS益处,生活质量,输血,和住院。机器人辅助胃切除术患者的安全性结果得到改善,还有直肠和肝切除.关于操作时间,结果是矛盾的。
结论:总之,关于RAS优势的结论性断言受到各种结局和程序中不一致和不足的低质量证据的阻碍.虽然RAS可能在某些手术领域提供潜在的优势,医疗保健决策还应考虑到证据质量有限,财务影响,和环境因素。此外,考虑应扩展到人体工程学方面,以维持健康的手术环境。
BACKGROUND: In surgical advancements, robot-assisted surgery (RAS) holds several promises like shorter hospital stays, reduced complications, and improved technical capabilities over standard care. Despite extensive evidence, the actual patient benefits of RAS remain unclear. Thus, our systematic
review aimed to assess the effectiveness and safety of RAS in visceral and thoracic surgery compared to laparoscopic or open surgery.
METHODS: We performed a systematic literature search in two databases (Medline via Ovid and The Cochrane Library) in April 2023. The search was restricted to 14 predefined thoracic and visceral procedures and randomized controlled trials (RCTs). Synthesis of data on critical outcomes followed the Grading of Recommendations, Assessment, Development, and Evaluation methodology, and the risk of bias was evaluated using the Cochrane Collaboration\'s Tool Version 1.
RESULTS: For five out of 14 procedures, no evidence could be identified. A total of 20 RCTs and five follow-up publications met the inclusion criteria. Overall, most studies had either not reported or measured patient-relevant endpoints. The majority of outcomes showed comparable results between study groups. However, RAS demonstrated potential advantages in specific endpoints (e.g., blood loss), yet these findings relied on a limited number of low-quality studies. Statistically significant RAS benefits were also noted in some outcomes for certain indications-recurrence, quality of life, transfusions, and hospitalisation. Safety outcomes were improved for patients undergoing robot-assisted gastrectomy, as well as rectal and liver resection. Regarding operation time, results were contradicting.
CONCLUSIONS: In summary, conclusive assertions on RAS superiority are impeded by inconsistent and insufficient low-quality evidence across various outcomes and procedures. While RAS may offer potential advantages in some surgical areas, healthcare decisions should also take into account the limited quality of evidence, financial implications, and environmental factors. Furthermore, considerations should extend to the ergonomic aspects for maintaining a healthy surgical environment.