Robotic Versus Laparoscopic Research Articles

Reply to Letter to Editor of Annals of Surgical Oncology in Relation to ‘Robotic Versus Laparoscopic Gastrectomy for Gastric Cancer: The Largest Systematic Reviews of 68,755 Patients and Meta‐analysis’, by Davey et al.

Reply to Letter to Editor of Annals of Surgical Oncology in Relation to ‘Robotic Versus Laparoscopic Gastrectomy for Gastric Cancer: The Largest Systematic Reviews of 68,755 Patients and Meta‐analysis’, by Davey et al.

Propensity Score-matched Donor and Recipient Outcomes: Robotic Versus Laparoscopic Donor Right Hepatectomy.

Few studies have examined the long-term outcomes of recipients in minimally invasive donor hepatectomies, particularly comparing robotic and laparoscopic donor procedures. Understanding these outcomes is crucial for optimizing surgical approaches and improving the overall success of living donor liver transplantation. This study aimed to compare the feasibility and safety of robotic donor right hepatectomy (RDRH) and laparoscopic donor right hepatectomy (LDRH) by evaluating total follow-up patient outcomes. This retrospective, single-center study included 117 and 118 donors who underwent RDRH and LDRH between March 2016 and June 2023, respectively. After performing 1:1 propensity score matching, 71 donor-recipient pairs were included in each group. Donor and recipient complications were divided into early (within 90 d) and late (after 90 d) biliary and vascular complications. In the matched cohort, major complication rates of donors were similar in both groups. Bile duct (BD) variation was not significantly different; however, the rates of multiple BD openings (26.8% versus 54.9%; P = 0.001) and major biliary complications in recipients were higher in the LDRH group (22.5% versus 42.3%; P = 0.012). The cumulative biliary complication rate was significantly higher in the LDRH group. Early biliary complications were not significantly different; however, the rate of late biliary complications was higher in the LDRH group (11.3 versus 23.9%; P = 0.047). RDRH demonstrated comparable postoperative complications to LDRH in donors but showed fewer recipient biliary complications. This could be attributed to the precision of robotic dissection and BD division, resulting in fewer multiple BD openings.

A Comprehensive Review on Comparative Analysis of Operative Efficiency and Postoperative Recovery in Robotic Versus Laparoscopic Hepatectomy

A Comprehensive Review on Comparative Analysis of Operative Efficiency and Postoperative Recovery in Robotic Versus Laparoscopic Hepatectomy

Robotic Versus Laparoscopic Pancreaticoduodenectomy for Pancreatic Cancer: Evaluation and Analysis of Surgical Efficacy.

Evidence is limited for the treatment of pancreatic cancer among minimally invasive pancreatoduodenectomy. This retrospective analysis evaluated patients who underwent robotic pancreaticoduodenectomy (RPD) or laparoscopic pancreaticoduodenectomy (LPD) from April 2016 to April 2023. Their baseline and perioperative data, including operative time, R0 resection rates, and severe complications rates, were analyzed, and the follow-up data, such as disease-free survival (DFS) and overall survival (OS), were collected. A total of 253 cases of LPD and RPD were performed, and 101 cases with pancreatic cancer were included, of which 54 were LPD and 47 were RPD. The conversion rate (4.3% vs. 29.6%, p=0.001) and blood loss (400 vs. 575 mL, p<0.05) were lower in the RPD group. No significant difference was observed between the two groups in terms of operative time, vessel resection rates, and TNM-stage diagnosis; however, R0 resection rates (80.9% vs. 70.4%) and lymph node harvest (24.2 vs. 21.9) had a higher tendency in the RPD group, and postoperative length of stay was shorter in the RPD cohort (11 vs. 13days). Moreover, improved 1- to 3-years DFS (75.7%, 61.7%, and 36.0% vs. 59.0%, 35.6%, and 21.9%) and OS (94.7%, 84.7%, and 50.8% vs. 84.1%, 63.6%, and 45.5%) was found in the RPD group in comparison with the LPD group. RPD had advantages in surgical safety and oncological outcomes compared with LPD, but was similar to the latter in perioperative outcomes. Long-term outcomes require further study.

Long-Term Outcomes of Robotic Versus Laparoscopic Total Mesorectal Excisions: A Propensity-Score Matched Cohort study of 5-year survival outcomes.

To compare long-term outcomes between laparoscopic and robotic total mesorectal excisions (TMEs) for rectal cancer in a tertiary center. Laparoscopic rectal cancer surgery has comparable long-term outcomes to the open approach, with several advantages in short-term outcomes. However, it has significant technical limitations, which the robotic approach aims to overcome. We included patients undergoing laparoscopic and robotic TME surgery between 2013 and 2021. The groups were compared after propensity-score matching. The primary outcome was 5-year overall survival (OS). Secondary outcomes were local recurrence (LR), distant recurrence (DR), disease-free survival (DFS), and short-term surgical and patient-related outcomes. A total of 594 patients were included, and after propensity-score matching 215 patients remained in each group. There was a significant difference in 5-year OS (72.4% for laparoscopy vs 81.7% for robotic, P = 0.029), but no difference in 5-year LR (4.7% vs 5.2%, P = 0.850), DR (16.9% vs 13.5%, P = 0.390), or DFS (63.9% vs 74.4%, P = 0.086). The robotic group had significantly less conversion (3.7% vs 0.5%, P = 0.046), shorter length of stay [7.0 (6.0-13.0) vs 6.0 (4.0-8.0), P < 0.001), and less postoperative complications (63.5% vs 50.7%, P = 0.010). This study shows a correlation between higher 5-year OS and comparable long-term oncological outcomes for robotic TME surgery compared to the laparoscopic approach. Furthermore, lower conversion rates, a shorter length of stay, and a less minor postoperative complications were observed. Robotic rectal cancer surgery is a safe and favorable alternative to the traditional approaches.

Robotic Versus Laparoscopic Liver Resection in Various Settings: An International Multicenter Propensity Score Matched Study of 10.075 Patients.

To compare the perioperative outcomes of robotic liver surgery (RLS) and laparoscopic liver surgery (LLS) in various settings. Clear advantages of RLS over LLS have rarely been demonstrated, and the associated costs of robotic surgery are generally higher than those of laparoscopic surgery. Therefore, the exact role of the robotic approach in minimally invasive liver surgery remains to be defined. In this international retrospective cohort study, the outcomes of patients who underwent RLS and LLS for all indications between 2009 and 2021 in 34 hepatobiliary referral centers were compared. Subgroup analyses were performed to compare both approaches across several types of procedures: (1) minor resections in the anterolateral (2, 3, 4b, 5, and 6) or (2) posterosuperior segments (1, 4a, 7, 8), and (3) major resections (≥3 contiguous segments). Propensity score matching was used to mitigate the influence of selection bias. The primary outcome was textbook outcome in liver surgery (TOLS), previously defined as the absence of intraoperative incidents ≥grade 2, postoperative bile leak ≥grade B, severe morbidity, readmission, and 90-day or in-hospital mortality with the presence of an R0 resection margin in case of malignancy. The absence of a prolonged length of stay was added to define TOLS+. Among the 10.075 included patients, 1.507 underwent RLS and 8.568 LLS. After propensity score matching, both groups constituted 1.505 patients. RLS was associated with higher rates of TOLS (78.3% vs 71.8%, P < 0.001) and TOLS+ (55% vs 50.4%, P = 0.026), less Pringle usage (39.1% vs 47.1%, P < 0.001), blood loss (100 vs 200 milliliters, P < 0.001), transfusions (4.9% vs 7.9%, P = 0.003), conversions (2.7% vs 8.8%, P < 0.001), overall morbidity (19.3% vs 25.7%, P < 0.001), and microscopically irradical resection margins (10.1% vs. 13.8%, P = 0.015), and shorter operative times (190 vs 210 minutes, P = 0.015). In the subgroups, RLS tended to have higher TOLS rates, compared with LLS, for minor resections in the posterosuperior segments (n = 431 per group, 75.9% vs 71.2%, P = 0.184) and major resections (n = 321 per group, 72.9% vs 67.5%, P = 0.086), although these differences did not reach statistical significance. While both produce excellent outcomes, RLS might facilitate slightly higher TOLS rates than LLS.

Updated Comparison of Robotic Versus Laparoscopic Donor Nephrectomy

Updated Comparison of Robotic Versus Laparoscopic Donor Nephrectomy

Robotic Versus Laparoscopic Abdominoperineal Resection for Locally Advanced Rectal Cancer Following Preoperative Chemoradiotherapy.

The usefulness of robotic surgery compared to laparoscopic surgery for rectal cancer has been reported; however, few reports exist on robotic abdominoperineal resection (APR). The aim of this study was to compare the outcomes of robotic and laparoscopic surgery to determine their usefulness in patients with locally advanced rectal cancer who had undergone preoperative chemoradiotherapy (CRT). This retrospective study included 43 patients with locally advanced rectal cancer who underwent preoperative CRT and robotic (22 patients) or laparoscopic APR (21 patients) between December 2012 and September 2022. We examined the short- and long-term outcomes in the robotic and laparoscopic groups. The median follow-up durations were 36 and 48 months for the robotic and laparoscopic groups, respectively. No significant differences in operative time, intraoperative blood loss, or overall complication rates were observed. However, the incidence of organ/space surgical site infection (SSI) was significantly lower in the robotic surgery group than in the laparoscopic group (9.1% vs. 38.1%, p=0.034) and the 3-year overall survival rate was significantly higher in the robotic surgery group than in the laparoscopic group (95% vs. 67%, p=0.029). Robotic APR was associated with a significantly lower rate of organ/space SSIs than the laparoscopic approach, indicating the usefulness of the robotic approach.

Comparison of Short-Term Outcomes After Robotic Versus Laparoscopic Radical Gastrectomy for Advanced Gastric Cancer in Elderly Individuals: A Propensity Score-Matching Study.

Robotic gastrectomy (RG) has been widely used to treat gastric cancer. However, whether the short-term outcomes of robotic gastrectomy are superior to those of laparoscopic gastrectomy (LG) for elderly patients with advanced gastric cancer has not been reported. The study enrolled of 594 elderly patients with advanced gastric cancer who underwent robotic or laparoscopic radical gastrectomy. The RG cohort was matched 1:3 with the LG cohort using propensity score-matching (PSM). After PSM, 121 patients were included in the robot group and 363 patients in the laparoscopic group. Excluding the docking and undocking times, the operation time of the two groups was similar (P = 0.617). The RG group had less intraoperative blood loss than the LG group (P < 0.001). The time to ambulation and first liquid food intake was significantly shorter in the RG group than in the LG group (P < 0.05). The incidence of postoperative complications did not differ significantly between the two groups (P = 0.14). Significantly more lymph nodes were dissected in the RG group than in the LG group (P = 0.001). Postoperative adjuvant chemotherapy was started earlier in the RG group than in the LG group (P = 0.02). For elderly patients with advanced gastric cancer, RG is safe and feasible. Compared with LG, RG is associated with less intraoperative blood loss; a faster postoperative recovery time, allowing a greater number of lymph nodes to be dissected; and earlier adjuvant chemotherapy.

Outcomes of Robotic Versus Laparoscopic Pancreatoduodenectomy Following Learning Curves of Surgeons

Objective: This study aimed to compare robotic pancreatoduodenectomy (RPD) with laparoscopic pancreatoduodenectomy (LPD) in operative and oncologic outcomes. Background: Previous studies comparing RPD with LPD have only been carried out in small, single-center studies with variable quality. Methods: Consecutive patients from nine centers in China who underwent RPD or LPD between 2015 and 2022 were included. A 1:1 propensity score matching (PSM) was used to minimize bias. Results: Of the 2,255 patients, 1158 underwent RPD and 1097 underwent LPD. Following PSM, 1006 patients were enrolled in each group. The RPD group had significantly shorter operative time (270.0 vs. 305.0 minutes, P&lt;0.001), lower intraoperative blood transfusion rate (5.9% vs. 12.0%, P&lt;0.001), lower conversion rate (3.8% vs. 6.7%, P=0.004), and higher vascular reconstruction rate (7.9% vs. 5.6%, P=0.040) than the LPD group. There were no significant differences in estimated blood loss, postoperative length of stay, perioperative complications, and 90-day mortality. Patients who underwent vascular reconstruction had similar outcomes between the two groups, although they had significantly lower estimated blood loss (300.0 vs. 360.0 mL; P=0.021) in the RPD group. Subgroup analysis on pancreatic ductal adenocarcinoma (PDAC) found no significant differences between the two groups in median recurrence-free survival (14.3 vs. 15.3 mo, P=0.573) and overall survival (24.1 vs. 23.7 mo, P=0.710). Conclusions: In experienced hands, both RPD and LPD are safe and feasible procedures with similar surgical outcomes. RPD had the perioperative advantage over LPD especially in vascular reconstruction. For PDAC patients, RPD resulted in similar oncological and survival outcomes as LPD.

IBC-Oxford University2023_BJSOral_16Surgical Outcomes of Totally Robotic Versus Laparoscopic Primary Bariatric Metabolic Surgeries

Abstract Background Over the past several years, the numbers of bariatric metabolic surgeries (BMS) performed robotic have been steadily increasing. Recent meta-analyses and registry reports find that primary surgeries performed robotic have similar outcomes to conventional laparoscopy but with longer operative times and higher costs. Most of the robotic surgeries in these reports, however, have been robot-assisted rather than totally (fully) robotic. The introduction of robotic staplers and conversion of the robotic system to the Xi platform now allow surgeons to perform bariatric surgeries totally robotic. Objectives To compare surgical outcomes of total robotic (TR) versus laparoscopic (LAP) primary bariatric metabolic surgeries (BMS) including sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and the biliopancreatic diversion with duodenal switch (DS). Methods The study is a retrospective analysis of 600 (302 TR and 298 LAP) primary BMS performed by a single surgeon between January 2020 and January 2023. Primary surgeries included 332 SG, 214 RYGB and 54 DS cases. Outcome measures included: 1) patient characteristics (age, weight, BMI, gender), 2) total number and incidence of preoperative co-morbidities, 3) operative time, 4) length of hospital stay (LOS), 5) complications, readmissions, and reoperations. Results Characteristics of the TR and LAP patients were similar, i.e., age = 45.5 vs. 44.9 y, respectively; BMI = 46.3 vs. 46.1; number major co-morbidities = 2.73 and 2.75. Operative times did not differ significantly between the TR and LAP approaches (84.3 vs. 88.2 min, respectively). LOS, however, was significantly (p&amp;lt;0.0001) less following surgeries performed totally robotic (1.16 days TR vs. 1.36 days LAP). There were no differences between the TR and LAP surgeries as regards 30-day readmission or reoperation rates but there was a trend toward fewer TR 30-day complications (2.3% TR vs. 5.0% LAP). With the RYGB, operative times were significantly lower for the totally robotic approach (99.6 min TR vs. 115.1 min LAP, p&amp;lt;0.0001) and LOS was significantly less (1.18 days TR vs. 1.38 days LAP, p&amp;lt;0.0001). For the SG, there were no significant differences between the TR and LAP approaches regarding operative times, but TR LOS was significantly (p&amp;lt;0.0001) less (1.13 days TR vs. 1.31 days LAP). Postoperative recovery rates (LOS) with the DS were also enhanced with the totally robotic approach (1.24 days TR vs. 1.58 days LAP, p=0.02), but operative times did not significantly differ (188.7 min TR, 176.5 min LAP). Conclusions Primary bariatric procedures (SG, RYGB, DS) performed totally robotic are as safe as conventional laparoscopy and have somewhat fewer complications, a faster rate of recovery, and,for the RYGB, shorter time in surgery.

The Evolving Surgical Landscape: A Comprehensive Review of Robotic Versus Laparoscopic Gastrectomy for the Treatment of Gastric Cancer.

Robotic gastrectomy has been gaining ground in the past 20 years. This study aims to (a) provide an updated and all-encompassing comprehensive review including post-operative outcomes, rate of complications, surgical efficiency and costs, pathology, overall survival, mortality and recurrence, and disease-free survival of robotic versus laparoscopic gastrectomy, (b) report research gaps, and (c) identify ongoing or forthcoming clinical trials that could potentially shed light on underreported findings within the existing literature. Regarding the methodology, PubMed and Google Scholar were searched for randomized controlled trials, systematic reviews, and meta-analyses published between January 2012 and October 2023. ClinicalTrials.gov was searched for related clinical trials currently underway or recruiting. Robotic gastrectomy, when compared to laparoscopic gastrectomy, for the treatment of gastric cancer, performs equally well or shows superiority in terms of the length of hospitalization, overall complications rates, rate of conversion to open surgery, surgical complications, anastomotic leakage, pancreatic complications, blood loss, mortality rates, time to first flatus, time to oral intake, distal and proximal resection margins, recurrence rate, reoperation rates, and overall survival. However, it is associated with higher costs and longer operative time. Parameters such as duodenal stump leakage, anastomosis stenosis, intestinal obstruction, ileus, delayed gastric emptying, wound complications, acute pancreatitis, pancreatic fistula, direct costs, time to initiation of adjuvant chemotherapy, postoperative morbidity, recurrence, and disease-free survival are currently underreported in the literature and necessitate for further research. Lastly, four clinical trials are currently underway or recruiting that could possibly bridge the research gap.

Robotic Versus Laparoscopic Donor Nephrectomy: A Retrospective Bicentric Comparison of Learning Curves and Surgical Outcomes From 2 High-volume European Centers.

Although laparoscopic donor nephrectomy (LDN) represents the gold-standard technique for kidney living donation, robotic donor nephrectomy (RDN) settled as another appealing minimally invasive technique over the past decades. A comparison between LDN and RDN outcomes was performed. RDN and LDN outcomes were compared, focusing on operative time and perioperative risk factors affecting surgery duration. Learning curves for both techniques were compared through spline regression and cumulative sum models. The study analyzed 512 procedures (154 RDN and 358 LDN procedures) performed between 2010 and 2021 in 2 different high-volume transplant centers. The RDN group presented a higher prevalence of arterial variations (36.2 versus 22.4%; P = 0.001) compared with the LDN cohort. No open conversions occurred; operative time (210 versus 195 min; P = 0.011) and warm ischemia time (WIT; 230 versus 180 s; P < 0.001) were longer in RDN. Postoperative complication rate was similar (8.4% versus 11.5%; P = 0.49); the RDN group showed shorter hospital stay (4 versus 5 d; P < 0.001). Spline regression models depicted a faster learning curve in the RDN group ( P = 0.0002). Accordingly, cumulative sum analysis highlighted a turning point after about 50 procedures among the RDN cohort and after about 100 procedures among the LDN group.Higher body mass index resulted as an independent risk factor for longer operative time for both techniques; multiple arteries significantly prolonged operative time in LDN, whereas RDN was longer in right kidney procurements; both procedures were equally shortened by growing surgical experience. RDN grants a faster learning curve and improves multiple vessel handling. Incidence of postoperative complications was low for both techniques.

ASO Author Reflections: The Robotic Versus Laparoscopic Approach to Left and Extended Left Hepatectomy.

ASO Author Reflections: The Robotic Versus Laparoscopic Approach to Left and Extended Left Hepatectomy.

Robotic Versus Laparoscopic Surgery for Rectal Cancer: A Comprehensive Review of Oncological Outcomes.

The treatment of rectal cancer is complex and involves specialized multidisciplinary care, although the tenet is still rooted in a high-quality total mesorectal excision. The robotic platform is one of many tools in the arsenal to assist dissection in the low pelvis. This article is a comprehensive review of the oncological outcome comparing robotic vs laparoscopic rectal cancer resection, with a particular focus on total mesorectal excision. There is no statistical difference in total mesorectal grade, circumferential margin, distal margin, and lymph node harvest. Survival data are less mature, but there is also no difference in disease-free or overall survival between the two techniques. Although additional randomized trials are still needed to validate these findings, both techniques are currently acceptable in the minimally invasive treatment of rectal cancer, and surgeon preference is paramount to safe and optimal resection.

Impact of Robotic Versus Laparoscopic Pyloroplasty on Short- and Long-term Outcomes in Patients with Gastroparesis

Impact of Robotic Versus Laparoscopic Pyloroplasty on Short- and Long-term Outcomes in Patients with Gastroparesis

Outcomes and Cost Analysis of Robotic Versus Laparoscopic Abdominoperineal Resection for Rectal Cancer: A Case-Matched Study.

Although laparoscopy for abdominoperineal resection has been well defined, the literature lacks comparative studies on robotic abdominoperineal resection. Because robotic abdominoperineal resections typically do not require splenic mobilization or an anastomosis for reconstruction, the mean console time is expected to be shorter than low anterior resection. We hypothesized that robotic and laparoscopic abdominoperineal resection would provide similar oncologic and financial outcomes. The study aimed to compare the perioperative, oncologic, and economic outcomes of the robotic and laparoscopic abdominoperineal resection. This was a retrospective, case-matched patient cohort. This study was conducted at a tertiary referral center. This study included all patients who underwent either laparoscopic or robotic abdominoperineal resections between January 2008 and April 2017; they were case-matched in a 1:1 ratio based on age ±5 years, BMI ±3 kg/m 2 , and sex criteria. Perioperative, oncologic, and economic (including survival) outcomes were compared. Because of institutional policy, actual cost values are presented as the lowest direct cost value as "100%," and other values are presented as proportional to the index value. We examined 68 patients (34 in each group). Both groups had similar preoperative characteristics, including preoperative chemoradiation rates. Operative time (319 vs 309 min), length of stay (7.2 vs 7.4 d), postoperative complications (38.2% vs 41.2%), conversion to open (5 vs 4), complete mesorectal excision (76.4% vs 79.4%), radial margin involvement (2.9% vs 8.9%), and direct hospital cost parameters (mean difference 26%, median difference 43%) were comparable between robotic and laparoscopic abdominoperineal resection groups, respectively (all p > 0.05). Local recurrence, disease-free survival, and overall survival rates (85.3% vs 76.5%) were also similar after 22 months of follow-up between the groups. The main limitations of this study are its retrospective nature and the variety in concomitant procedures. Robotic abdominoperineal resections provided in carefully matched patients with rectal cancer showed similar perioperative and short-term oncologic outcomes compared to laparoscopic abdominoperineal resections. Our study was not powered to detect a significant increase in cost with robotic abdominoperineal resections. See Video Abstract at http://links.lww.com/DCR/B920 . ANTECEDENTES:Si bien la resección abdominoperineal laparoscópica está bien definida, la literatura carece de estudios comparativos sobre la resección abdominoperineal robótica. Dado que las resecciones abdominoperineales robóticas generalmente no requieren movilización esplénica o una anastomosis en casos de reconstrucción, se supone que el tiempo medio en la consola sea más corto que durante una resección anterior baja. Hipotéticamente las resecciones abdominoperineales robóticas y laparoscópicas nos proporcionarían resultados oncológicos y económicos similares.OBJETIVO:Comparar los resultados perioperatorios, oncológicos y económicos de la resección abdominoperineal robótica y laparoscópica.DISEÑO:Esta fue una cohorte de pacientes retrospectiva, emparejada por casos.AJUSTE:Estudio realizado en un centro de referencia terciario.PACIENTES:Todos los pacientes que se sometieron a resecciones abdominoperineales LAParoscópicas o ROBóticas entre Enero de 2008 y Abril de 2017 fueron identificados y emparejados según la edad ±5, el IMC ±3 y los criterios de sexo en una proporción de 1:1.PRINCIPALES MEDIDAS DE RESULTADO:Se compararon los resultados perioperatorios, oncológicos y económicos (incluida la sobrevida). Debido a la política institucional, los valores de costos reales se presentan como el valor de costo directo más bajo al 100% y los otros valores se presentan como proporcionales al valor índice.RESULTADOS:Se analizaron 68 pacientes (LAP-34 y ROB-34). Ambos grupos tenían características preoperatorias similares, incluidas las tasas de radio-quimioterapia pre-operatoria. Los tiempos operatorios fueron de 319 y 309 minutos, la estadía hospitalaria de 7 días en los dos grupos, las complicaciones post-operatorias fueron de 38,2% LAP frente a 41,2% ROB, la tasa de conversion fué de 5 a 4, la excisión total del mesorrecto de 76,4% frente a 79,4%, la resección radial con afectación de los márgenes de 2,9% frente a 8,9% y los parámetros de costes hospitalarios directos (diferencia de medias 26%, diferencia de medianas 43%) fueron comparables entre los grupos, de resección abdominoperineal robótica y laparoscópica, respectivamente (todos p > 0,05). Las tasas de recurrencia local, sobrevida libre de enfermedad y sobrevida general (85,3% frente a 76,5%) también fueron similares después de 22 meses de seguimiento entre los grupos.LIMITACIONES:La naturaleza retrospectiva y la variedad de procedimientos concomitantes fueron las principales limitaciones de este estudio.CONCLUSIONES:Las resecciones abdominoperineales robóticas proporcionaron resultados oncológicos perioperatorios y a corto plazo similares en pacientes con cáncer de recto cuidadosamente emparejados en comparación con las resecciones abdominoperineales laparoscópicas. Nuestro estudio no fue diseñado para detectar un aumento significativo en el costo relacionado con la resección abdominoperineal robótica. Consulte Video Resumen en http://links.lww.com/DCR/B920 . (Traducción-Dr. Xavier Delgadillo ).

Short Term Safety and Efficacy of Robotic Versus Laparoscopic Liver Resection: A Systematic Review and Meta Analysis

Introduction: Laparoscopic liver resection (LLR) remains technically challenging with its use limited to experienced surgeons. Robotic liver resection (RLR) may potentially produce favorable peri- and postoperative outcomes when compared to LLR. Methods: MEDLINE, EMBASE, PubMed, and Cochrane CENTRAL databases were systematically reviewed to identify studies comparing robotic and laparoscopic partial hepatectomy (last search 5th August 2019). Quantitative comparative studies in English published since the introduction of RLR were identified for inclusion. Outcomes extracted include operative time (OT), estimated blood loss (EBL), conversion to open, perioperative transfusion requirement, post-operative complications, length of stay, R0 resection rate, and mortality. Sub-groups were defined as major, and minor resections. Meta-analysis and subgroup meta-analysis was carried out using a random effects model. Effect measures were odds ratio (OR) for dichotomous data and mean weighted difference (MWD) for continuous data. Results: Twenty-two non-randomised comparative studies with a total of 1890 patients (Robotic; n=836, Laparoscopic; n=1054) was included in analysis. Operative time was significantly longer for RLR [MWD=+39.8 minutes, 95% CI (21.1, 58.6), p< 0.001], but not significantly different in sub-group analysis. EBL, length of stay, conversion rate, transfusion, complication rate, R0 resection rate, and mortality was not significantly different between RLR and LLR nor in major or minor sub-groups [p>0.05]. Conclusion: RLR provides comparable peri- and postoperative outcomes to LLR, potentially being a preferable approach in complex and major liver resections due to the inherent advantages of the robotic platform. Further randomised controlled studies are required in establishing the role of robotics in liver resection.

Effects of Robotic Versus Laparoscopic Surgery for Rectal Cancer on Male Urinary Function: a Meta-analysis

The purpose of this study was to evaluate whether robotic surgery is superior to laparoscopic surgery for protecting urinary function in male patients with rectal cancer. We systematically searched PubMed, Web of Science Core Collection, Cochrane Library, and Embase databases for relevant articles in April 2020. All articles about the differences between robotic and laparoscopic surgeries for rectal cancer were identified. The patients’ urinary function was assessed using the International Prostate Symptom Score (IPSS). After searching, eight studies with 955 male patients were included. Four hundred sixty-six male patients were included in the robotic group, and 489 male patients were included in the laparoscopic group. Statistical analysis of the IPSS scores indicated that robotic surgery provided better recovery of male urinary function than laparoscopic surgery at 3 and 12 months post-operatively (mean difference(MD), − 1.26; 95% CI, − 2.24 to − 0.07; p = 0.04; and MD, − 1.02; 95% CI, − 1.79 to − 0.25; p = 0.009); there was no significant difference between the two groups at 6 months post-operatively (MD, − 0.76; 95% CI, − 1.73 to 0.21; p = 0.12). Therefore, we concluded that robotic rectal cancer surgery is more effective than laparoscopic rectal cancer surgery in protecting male urinary function.

Perioperative Outcomes of Robotic Versus Laparoscopic Sleeve Gastrectomy in the Super-obese

BackgroundThe robotic platform is often used for bariatric surgery in superobese patients (body mass index ≥ 50 kg/m2) with the assumption that it offers a technical advantage. This study aimed to compare perioperative outcomes of robotic-assisted sleeve gastrectomy (RSG) and laparoscopic sleeve gastrectomy (LSG) in superobese patients. MethodsThe Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database was queried for superobese patients undergoing nonrevisional RSG and LSG from 2015 through 2017. Univariate analysis and multivariable logistic regression were used to compare outcomes in RSG and LSG. ResultsA total of 61,493 patients (4685 RSG and 56,808 LSG) were identified. Patients were similar in terms of age (RSG 42.3 ± 11.8 versus LSG 42.4 ± 11.7 y; P = 0.60) and body mass index (RSG 56.8 ± 6.9 versus LSG 56.9 ± 7.1 kg/m2; P = 0.17). The RSG group had a longer operative time (102.4 ± 46.0 versus 74.7 ± 37.5 min; P < 0.01) and length of stay (1.79 ± 1.78 versus 1.66 ± 1.51 d; P < 0.01). Overall morbidity (RSG 3.5% versus LSG 3.7%; P = 0.54) and mortality (RSG 0.1% versus LSG 0.1%; P = 0.73) were similar between the two groups. After adjustment, RSG represented an independent risk factor for organ-space surgical site infection (adjusted odds ratio 2.70; 95% confidence interval 1.54-4.73; P < 0.01). ConclusionsUse of RSG in superobese patients infers higher risk for organ-space surgical site infection and is associated with prolonged operative time and length of stay. This questions the role of robotics in superobese patients undergoing sleeve gastrectomy.