Robotic versus laparoendoscopic single-site hysterectomy: a systematic review and meta-analysis
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REVIEW ARTICLE
Robotic versus laparoendoscopic single‑site hysterectomy: a systematic review and meta‑analysis Anastasia Prodromidou1,2 · Eleftherios Spartalis1,3 · Gerasimos Tsourouflis1,3 · Dimitrios Dimitroulis1,3 · Nikolaos Nikiteas1,3 Received: 5 October 2019 / Accepted: 6 January 2020 © Springer-Verlag London Ltd., part of Springer Nature 2020
Abstract Single-site hysterectomy (SSH) laparoscopic or robotic presented distinct advantages with regards to postoperative cosmetic outcome, wound-related complications and morbidity. We aimed to evaluate the feasibility of robotic and laparoscopic SSH in patients with benign or early-stage malignant gynecological conditions and to compare the two approaches. A systematic search of four electronic databases for articles published up to September 2019 was performed. Studies reporting outcomes for women who underwent robotic or laparoscopic SSH were considered eligible. A total of 6 studies with 412 patients were included. Among them, 150 women had robotic SSH, whereas 262 had laparoscopic SSH. Neither total operative time nor total hysterectomy time were found different among the 2 groups (355 patients MD 17.47 min, 95% CI − 5.82 to 40.76, p = 0.14 and 285 patients MD 6.41 min, 95% CI − 10.24 to 23.06, p = 0.45, respectively). Robotic approach presented significantly lower blood loss and hospital stay compared to laparoscopic (287 patients MD − 10.84 ml 95% CI − 20.35 to − 1.32, p = 0.03, 328 patients MD − 0.32 days, 95% CI − 0.44 to − 0.19, p 20 patients which addressed at least one postoperative outcome after the aforementioned procedures were finally recruited in the present study. Case reports, reviews and animal studies were excluded from the present meta-analysis. Accordingly, noncomparative (prospective or retrospective) observational studies were excluded from tabulation. Each author independently reviewed the literature; the discrepancies during the data collection were then resolved by consensus of all authors.
Literature search and data collection A systematic search of the PubMed (1966–2019), Scopus (2004–2019), Google Scholar (2004–2019) and Clinicaltrials.gov databases for articles published up to September 2019 was performed. Reference lists of articles, which were retrieved in full text, were systematically searched for relevant articles in the field. The following key words were used for the search: “single site”, “single incision”, “robotic hysterectomy”, “laparoscopic hysterectomy”, “minimally
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Journal of Robotic Surgery
invasive”. The PRISMA flow diagram schematically presents the stages of article selection (Fig. 1).
Quality assessment The quality of all the included studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) [11]. The MINORS scale was used due to the fact that all except one of the studies included in our metaanalysis were non-randomized.
Statistical analysis Statistical meta-analysis was performed using the RevMan 5.3 software (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaborat
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