Robotic-assisted versus conventional/single-incision laparoscopic cholecystectomy for benign gallbladder disease: A systematic review and meta-analysis

摘要

BACKGROUND: Robotic surgery has shown great advantages in many complicated endoscopic operations compared with laparoscopic surgery. However robotic-assisted cholecystectomy (RAC) is still a controversial issue compared with conventional/single-incision laparoscopic cholecystectomy (CLC/SILC). The aim of this study was to compare the safety and efficacy of RAC with CLC/SILC for benign gallbladder disease. METHODS: Embase, Medline, Pubmed, and Cochrane library databases were searched to obtain comparative studies evaluating the safety and efficacy between RAC and CLC/SILC. Only randomized trials and non-randomized studies with propensity score matching were included. Statistical analysis was performed through Stata software, random effects models were applied. RESULTS: A total of 17 studies, including 12 studies for RAC versus CLC and 5 studies for RAC versus SILC, were included in the study. A total of 75,866 patients were included in the study, of whom 37,471 patients underwent RAC, 38,123 patients underwent CLC, and 272 patients underwent SILC. Compared with CLC/SILC, RAC significantly increased operative time (standardized mean difference [SMD] 0.79 minutes; 95% confidence interval [CI] 0.30, 1.28) and hospitalization costs (SMD 1.82; 95% CI 0.27, 3.36). At the same time, RAC significantly reduced conversion rate (relative risk [RR] 0.58; 95% CI 0.52, 0.63). There were no significant differences between the groups in the length of hospital stay (SMD 0.04; 95% CI -0.02, 0.11), intraoperative complications (RR 0.99; 95% CI 0.61, 1.59), estimate blood loss (SMD 0.03; 95% CI -0.19, 0.25), and incisional hernia (RR 2.51; 95% CI 0.69, 9.10). CONCLUSION: RAC is a safe and effective procedure with lower conversion rate and comparable rate of complications compared with CLC/SILC.