Abstract
AimTo conduct a meta-analysis to determine the relative merits between robotic video-assisted thoracoscopic surgery (R-VATS) and conventional video-assisted thoracoscopic surgery (VATS) for lung cancer.ResultsFifteen studies matched the selection criterion, which reported 8827 subjects, of whom 1704 underwent R-VATS and 7123 underwent VATS. Compared the perioperative outcomes with VATS, reports of R-VATS indicated unfavorable outcomes considering the operative time (SMD = 0.48, 95% CI 0.15 to 0.81). Meanwhile, the number of dissected lymph nodes (SMD = 0.12, 95% CI −0.27 to 0.51) and hospital stay following surgery (SMD = −0.1; 95% CI −0.27 to 0.07), conversion (RR = 0.68; 95% CI 0.42 to 1.11), morbidity (RR = 0.99, 95% CI 0.92 to 1.07) and mortality (RR = 0.33, 95% CI 0.1 to 1.09) were similar for both procedures.Materials and MethodsA literature search was performed to identify comparative studies reporting perioperative outcomes for R-VATS and VATS for lung cancer. Pooled risk ratio (RR) and standardized mean differences (SMDs) with 95% confidence intervals (95% CIs) were calculated using either the fixed effects model or the random effects model.ConclusionsThere is no difference in terms of perioperative outcomes between R-VATS and VATS except for the operative time which is significantly high for R-VATS. Further studies are required to confirm these results.
Highlights
The introduction of minimally invasive surgery (MIS) has opened new possibilities in various surgical fields
Compared the perioperative outcomes with video-assisted thoracic surgery (VATS), reports of robotic video-assisted thoracoscopic surgery (R-VATS) indicated unfavorable outcomes considering the operative time (SMD = 0.48, 95% confidence intervals (95% CIs) 0.15 to 0.81)
The number of dissected lymph nodes (SMD = 0.12, 95% CI −0.27 to 0.51) and hospital stay following surgery (SMD = −0.1; 95% CI −0.27 to 0.07), conversion (RR = 0.68; 95% CI 0.42 to 1.11), morbidity (RR = 0.99, 95% CI 0.92 to 1.07) and mortality (RR = 0.33, 95% CI 0.1 to 1.09) were similar for both procedures
Summary
The introduction of minimally invasive surgery (MIS) has opened new possibilities in various surgical fields. Benefits of video-assisted thoracic surgery (VATS) have been reported for its shorter length of hospital stay, decreased pain, a more rapid return to normal activity [1,2,3]. Video-assisted thoracoscopic surgery (VATS) is widely accepted as a safe and useful approach for the management of various thoracic conditions [4]. VATS still remains a technically challenging procedure owing to its two-dimensional visual representation and use of nonflexible endoscopic instruments. Robotic surgery was introduced as an evolution of video-assisted thoracic surgery while maintaining advantages in part to overcome the limitations of VATS at the end of 1990s. The robotic approach has many advantages, which include greater flexibility and higher definition threedimensional vision, more intuitive movements and comfort of the surgeon via the use of wrist instruments [5, 6]
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