Surgical Endoscopy

, Volume 32, Issue 3, pp 1104–1110 | Cite as

Robotic versus laparoscopic right colectomy: an updated systematic review and meta-analysis

  • Leonardo Solaini
  • Francesca Bazzocchi
  • Davide Cavaliere
  • Andrea Avanzolini
  • Alessandro Cucchetti
  • Giorgio Ercolani
Review

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

Keywords

Robotic Laparoscopy Minimally invasive colectomy Right hemicolectomy Meta-analysis 

Notes

Compliance with ethical standards

Disclosures

Drs. Leonardo Solaini, Francesca Bazzocchi, Davide Cavaliere, Andrea Avanzolini, Alessandro Cucchetti, and Giorgio Ercolani have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Formisano G, Misitano P, Giuliani G, Calamati G, Salvischiani L, Bianchi PP (2016) Laparoscopic versus robotic right colectomy: technique and outcomes. Updates Surg 68(1):63–69.  https://doi.org/10.1007/s13304-016-0353-4 CrossRefPubMedGoogle Scholar
  2. 2.
    Zerey M, Hawver LM, Awad Z, Stefanidis D, Richardson W, Fanelli RD (2013) SAGES evidence-based guidelines for the laparoscopic resection of curable colon and rectal cancer. Surg Endosc 27(1):1–10.  https://doi.org/10.1007/s00464-012-2592-x CrossRefPubMedGoogle Scholar
  3. 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
  4. 4.
    deSouza AL, Prasad LM, Park JJ, Marecik SJ, Blumetti J, Abcarian H (2010) Robotic assistance in right hemicolectomy: is there a role? Dis Colon Rectum 53(7):1000–1006.  https://doi.org/10.1007/DCR.0b013e3181d32096 CrossRefPubMedGoogle Scholar
  5. 5.
    Deutsch GB, Sathyanarayana SA, Gunabushanam V, Mishra N, Rubach E, Zemon H, Klein JD, Denoto G 3rd (2012) Robotic vs. laparoscopic colorectal surgery: an institutional experience. Surg Endosc 26 (4):956–963.  https://doi.org/10.1007/s00464-011-1977-6 CrossRefPubMedGoogle Scholar
  6. 6.
    Park JS, Choi GS, Park SY, Kim HJ, Ryuk JP (2012) Randomized clinical trial of robot-assisted versus standard laparoscopic right colectomy. Br J Surg 99(9):1219–1226.  https://doi.org/10.1002/bjs.8841 CrossRefPubMedGoogle Scholar
  7. 7.
    Rawlings AL, Woodland JH, Vegunta RK, Crawford DL (2007) Robotic versus laparoscopic colectomy. Surg Endosc 21(10):1701–1708.  https://doi.org/10.1007/s00464-007-9231-y CrossRefPubMedGoogle Scholar
  8. 8.
    Lorenzon L, Bini F, Balducci G, Ferri M, Salvi PF, Marinozzi F (2016) Laparoscopic versus robotic-assisted colectomy and rectal resection: a systematic review and meta-analysis. Int J Colorectal Dis 31(2):161–173.  https://doi.org/10.1007/s00384-015-2394-4 CrossRefPubMedGoogle Scholar
  9. 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. 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
  11. 11.
    Xu H, Li J, Sun Y, Li Z, Zhen Y, Wang B, Xu Z (2014) Robotic versus laparoscopic right colectomy: a meta-analysis. World J Surg Oncol 12:274.  https://doi.org/10.1186/1477-7819-12-274 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Zarak A, Castillo A, Kichler K, de la Cruz L, Tamariz L, Kaza S (2015) Robotic versus laparoscopic surgery for colonic disease: a meta-analysis of postoperative variables. Surg Endosc 29(6):1341–1347.  https://doi.org/10.1007/s00464-015-4197-7 CrossRefPubMedGoogle Scholar
  13. 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
  14. 14.
    Shin JY (2012) Comparison of short-term surgical outcomes between a robotic colectomy and a laparoscopic colectomy during early experience. J Korean Soc Coloproctol 28(1):19–26.  https://doi.org/10.3393/jksc.2012.28.1.19 CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Davis BR, Yoo AC, Moore M, Gunnarsson C (2014) Robotic-assisted versus laparoscopic colectomy: cost and clinical outcomes. J Soc Laparoendosc Surg 18(2):211–224.  https://doi.org/10.4293/108680813X13753907291035 CrossRefGoogle Scholar
  16. 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
  17. 17.
    Dolejs SC, Waters JA, Ceppa EP, Zarzaur BL (2016) Laparoscopic versus robotic colectomy: a national surgical quality improvement project analysis. Surg Endosc.  https://doi.org/10.1007/s00464-016-5239-5 Google Scholar
  18. 18.
    Kang J, Park YA, Baik SH, Sohn SK, Lee KY (2016) A comparison of open, laparoscopic, and robotic surgery in the treatment of right-sided colon cancer. Surg Laparosc Endosc Percutan Tech 26(6):497–502.  https://doi.org/10.1097/SLE.0000000000000331 CrossRefPubMedGoogle Scholar
  19. 19.
    Lujan HJ, Plasencia G, Rivera BX, Molano A, Fagenson A, Jane LA, Holguin D (2017) Advantages of robotic right colectomy with intracorporeal anastomosis. Surg Laparosc Endosc Percutan Tech.  https://doi.org/10.1097/SLE.0000000000000384 Google Scholar
  20. 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
  21. 21.
    Moher D, Liberati A, Tetzlaff J, Altman DG (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8(5):336–341.  https://doi.org/10.1016/j.ijsu.2010.02.007 CrossRefPubMedGoogle Scholar
  22. 22.
    Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17(1):1–12.  https://doi.org/10.1016/0197-2456(95)00134-4 CrossRefPubMedGoogle Scholar
  23. 23.
    Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73(9):712–716.  https://doi.org/10.1046/j.1445-2197.2003.02748.x CrossRefPubMedGoogle Scholar
  24. 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
  25. 25.
    Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5(1):13.  https://doi.org/10.1186/1471-2288-5-13 CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  1. 1.General and Oncologic SurgeryMorgagni-Pierantoni Hospital, Ausl RomagnaForlìItaly
  2. 2.Department of Medical and Surgical Sciences, DIMEC, S.Orsola-Malpighi Hospital, Alma Mater StudiorumUniversity of BolognaBolognaItaly

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