Robotic versus laparoscopic right colectomy: an updated systematic review and meta-analysis
In the right colon surgery, there is a growing literature comparing the safety of robotic right colectomy (RRC) to that of laparoscopic right colectomy (LRC). With this paper we aim to systematically revise and meta-analyze the latest comparative studies on these two minimally invasive procedures.
A systematic review of studies published from 2000 to 2017 in the PubMed, Scopus, and Embase databases was performed. Primary endpoints were postoperative morbidity and mortality. Secondary endpoints were blood loss, conversion to open surgery, harvested lymph node anastomotic leak, postoperative hemorrhage, abdominal abscess, postoperative ileus, time to first flatus, non-surgical complications, wound infections, hospital stay, and incisional hernia and costs. A subgroup analysis was performed on those series presenting only extracorporeal anastomosis in both arms.
After screening 355 articles, 11 articles with a total of 8257 patients were eligible for inclusion. Operative time was found to be significantly shorter for the laparoscopic procedures in the pooled analysis (SMD − 0.99 95% CI − 1.4 to − 0.6, p < 0.001). Conversion to open surgery was more common during laparoscopic procedures than during the robotic ones (RR 1.7; 95% CI 1.1–2.6, p = 0.02). No significant differences in mortality (RR 0.47; 95% CI 0.18–1.23, p = 0.124) and postoperative complications (RR 1.05; 95% CI 0.9–1.2, p = 0.5) were found between LRC versus RRC. The pooled mean time to first flatus was higher in the laparoscopic group (SMD 0.85 days; 95% CI 0.16–1.54, p = 0.016). Hospital costs were significantly higher in RRCs (SMD − 0.52; 95% CI − 0.52 to − 0.04, p = 0.035).
RRC can be regarded as a feasible and safe technique. Its superiority in terms of postoperative recovery must be confirmed by further large prospective series comparing RRC and LRC performed with the same anastomotic technique. RRC seemed to be associated with higher costs than LRC.
KeywordsRobotic Laparoscopy Minimally invasive colectomy Right hemicolectomy Meta-analysis
Compliance with ethical standards
Drs. Leonardo Solaini, Francesca Bazzocchi, Davide Cavaliere, Andrea Avanzolini, Alessandro Cucchetti, and Giorgio Ercolani have no conflicts of interest or financial ties to disclose.
- 3.Casillas MA Jr, Leichtle SW, Wahl WL, Lampman RM, Welch KB, Wellock T, Madden EB, Cleary RK (2014) Improved perioperative and short-term outcomes of robotic versus conventional laparoscopic colorectal operations. Am J Surg 208(1):33–40. https://doi.org/10.1016/j.amjsurg.2013.08.028 CrossRefPubMedGoogle Scholar
- 9.Petrucciani N, Sirimarco D, Nigri GR, Magistri P, La Torre M, Aurello P, D’Angelo F, Ramacciato G (2015) Robotic right colectomy: a worthwhile procedure? Results of a meta-analysis of trials comparing robotic versus laparoscopic right colectomy. J Minim Access Surg 11(1):22–28. https://doi.org/10.4103/0972-9941.147678 CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Rondelli F, Balzarotti R, Villa F, Guerra A, Avenia N, Mariani E, Bugiantella W (2015) Is robot-assisted laparoscopic right colectomy more effective than the conventional laparoscopic procedure? A meta-analysis of short-term outcomes. Int J Surg 18:75–82. https://doi.org/10.1016/j.ijsu.2015.04.044 CrossRefPubMedGoogle Scholar
- 13.Delaney CP, Lynch AC, Senagore AJ, Fazio VW (2003) Comparison of robotically performed and traditional laparoscopic colorectal surgery. Dis Colon Rectum 46(12):1633–1639. https://doi.org/10.1097/01.DCR.0000098941.42470.D9 CrossRefPubMedGoogle Scholar
- 16.de’Angelis N, Lizzi V, Azoulay D, Brunetti F (2016) Robotic versus laparoscopic right colectomy for colon cancer: analysis of the initial simultaneous learning curve of a surgical fellow. J Laparoendosc Adv Surg Tech A 26(11):882–892. https://doi.org/10.1089/lap.2016.0321 CrossRefPubMedGoogle Scholar
- 20.Trastulli S, Coratti A, Guarino S, Piagnerelli R, Annecchiarico M, Coratti F, Di Marino M, Ricci F, Desiderio J, Cirocchi R, Parisi A (2015) Robotic right colectomy with intracorporeal anastomosis compared with laparoscopic right colectomy with extracorporeal and intracorporeal anastomosis: a retrospective multicentre study. Surg Endosc 29(6):1512–1521. https://doi.org/10.1007/s00464-014-3835-9 CrossRefPubMedGoogle Scholar
- 24.Freeman MF, Tukey JW (1950) Transformations related to the angular and the square root. Ann Math Statist (4):607–611. https://doi.org/10.1214/aoms/1177729756