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Robotic-assisted versus laparoscopic cholecystectomy for benign gallbladder diseases: a systematic review and meta-analysis

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Abstract

Background

Robotic surgery, an emerging technology, has some potential advantages in many complicated endoscopic procedures compared with laparoscopic surgery. But robot-assisted cholecystectomy (RAC) is still a controversial issue on its comparative merit compared with conventional laparoscopic cholecystectomy (LC). The aim of this study was to evaluate the safety and efficacy of RAC compared with LC for benign gallbladder disease.

Methods

A systematic literature search was conducted using the PubMed, EMBASE, and Cochrane Library databases (from their inception to December 2017) to obtain comparative studies assessing the safety and efficacy between RAC and LC. The quality of the literature was assessed, and the data analyzed using R software, random effects models were applied.

Results

Twenty-six studies, including 5 RCTs and 21 NRCSs (3 prospective plus 18 retrospective), were included. A total of 4004 patients were included, of which 1833 patients (46%) underwent RAC and 2171 patients (54%) underwent LC. No significant differences were found in intraoperative complications, postoperative complications, readmission rate, hospital stay, estimated blood loss, and conversion rate between RAC and LC groups. However, RAC was related to longer operative time compared with LC (MD = 12.04 min, 95% CI 7.26–16.82) in RCT group, which was consistent with NRCS group; RAC also had a higher rate of incisional hernia in NRCS group (RR = 3.06, 95% CI 1.42–6.57), and one RCT reported that RAC was similar to LC (RR = 7.00, 95% CI 0.38–129.84).

Conclusions

The RAC was not found to be more effective or safer than LC for benign gallbladder diseases, which indicated that RAC is a developing procedure instead of replacing LC at once. Given the higher costs, the current evidence is in favor of LC in cholecystectomy.

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Acknowledgements

Xinyi Shan and Liang Yao gave many suggestions during the revision phase of the paper. The authors would like to thank the institution (Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University) for their contribution toward the statistical study design and study data analysis.

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Author notes

  1. Caiwen Han, Xinyi Shan, and Liang Yao are Co-first authors.

Authors and Affiliations

  1. Department of General Surgery, Gansu Provincial Hospital, 204 Donggang West Road, Lanzhou, 730000, People’s Republic of China

    Caiwen Han, Xinyi Shan, Lidong Hu, Hongwei Tian, Wutang Jing, Binbin Du & Tiankang Guo

  2. Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, People’s Republic of China

    Caiwen Han & Lidong Hu

  3. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People’s Republic of China

    Kehu Yang

  4. School of Public Health, Lanzhou University, Lanzhou, 730000, People’s Republic of China

    Meixuan Li

  5. Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, People’s Republic of China

    Caiwen Han, Xinyi Shan, Liang Yao, Peijing Yan, Meixuan Li, Lidong Hu, Lixia Wang, Kehu Yang & Tiankang Guo

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  1. Caiwen Han
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Correspondence to Kehu Yang or Tiankang Guo.

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Caiwen Han, Xinyi Shan, Liang Yao, Peijing Yan, Meixuan Li, Lidong Hu, Hongwei Tian, Binbin Du, Wutang Jing, Lixia Wang, Tiankang Guo, and Kehu Yang have declared that no conflict of interest or financial ties to disclose.

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Han, C., Shan, X., Yao, L. et al. Robotic-assisted versus laparoscopic cholecystectomy for benign gallbladder diseases: a systematic review and meta-analysis. Surg Endosc 32, 4377–4392 (2018). https://doi.org/10.1007/s00464-018-6295-9

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