Kandace M Kichler, MD, Alberto Zarak, MD, Alvaro Castillo, MD, Lucy M De La Cruz, MD, Leonardo Tamariz, MD, MPH, Srinivas Kaza, MD, FACS. University of Miami, Regional Campus, West Palm Beach, Florida.
BACKGROUND: The use of Robotic surgery has been proven to be a safe and effective alternative to laparoscopic techniques in the treatment of colorectal diseases, although drawbacks noted such as increase operative time (OT) and higher cost have been documented. This meta-analysis was done to compare laparoscopic colectomy (LC) versus robotic colectomy (RC) in terms operative time (OT), estimated blood loss (EBL) and conversion rate.
METHODS: We performed a MEDLINE database search with secondary referencing to identify studies suitable for inclusion. Selected studies included those in which LC and RC were compared in terms of post-operative outcomes. We calculated the I squared statistic as a measure of heterogeneity. We used fixed and random effects models to calculate the standardized mean difference (SMD) and Odds ratio (OR) of the outcomes between the LC and RC groups.
RESULTS: Seven studies with a total of 694 cases were analyzed; of these, 236 were RC cases and 458 were LC cases. Only 39.3% (273 patients) suffered from benign disease requiring colectomy, whereas the remaining 60.7% (421 patients) underwent colon resection for malignancy. LC had significantly lower OT compared to RC (p<0.01) for right or left colon. Right RC had the least EBL (pvalue<0.01). The OR for conversion rate was 0.3 (0.1-1.25) p=0.11 for LC when compared to RC.
CONCLUSIONS: Laparoscopic colectomy had a significantly lower operative time than robotic colectomy. Both operative techniques had similar conversion rates, however, right robotic colectomy had the least EBL.
|SMD (95% CI) p value for OR time||SMD( 95% CI)p value for estimated blood loss|
|Left||-0.66 (-0.90-0.42) < 0.01||0.17 (-0.4-0.8) 0.57|
|Right||-0.72 (0-.91-0.57) < 0.01||0.6 (0.4-0.8) < 0.01|