State of the art in robotic liver surgery: a meta-analysis
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ORIGINAL ARTICLE
State of the art in robotic liver surgery: a meta‑analysis Zhiming Zhao1 · Zhuzeng Yin1 · Mengyang Li2 · Nan Jiang1 · Rong Liu1 Received: 5 May 2020 / Accepted: 20 October 2020 © Italian Society of Surgery (SIC) 2020
Abstract Although the number of robotic hepatectomy (RH) performed is increasing, few studies have reported its efficacy in comparison with the conventional surgical modalities. The aim of this meta-analysis was to evaluate the perioperative results of RH vs. open hepatectomy (OH) and RH vs. laparoscopic hepatectomy (LH). We systematically searched for English papers published in PubMed (Medline), Embase, and Cochrane library before March 1, 2020. A total of 39 papers and 2999 patients were eventually included. Among the included patients, 1249, 1010, and 740 underwent RH, LH, and OH, respectively. Compared with OH, the operation time was significantly increased but the intraoperative blood loss, blood transfusion rate, incidence of severe complications, and length of postoperative hospitalization were significantly reduced in patients with RH. However, there was no significant difference in the use of Pringle maneuver and overall incidence of complications. Compared with LH, the operation time was significantly increased, and the intraoperative blood loss was also more in RH. However, there were no differences in blood transfusion rate, use of Pringle maneuver, incidence of complications, incidence of severe complications, and length of postoperative hospitalization between the two groups. A longer operation time remains the main shortcoming of RH. However, based on the perioperative clinical efficacy, we conclude that RH is comparable to LH but is better than OH for selected patients. Keywords Robotic · Laparoscopic · Hepatectomy · Liver · Surgery
Introduction Hepatectomy is the most effective treatment modality for patients with benign and malignant liver tumors. Compared with open hepatectomy (OH), laparoscopic hepatectomy (LH) has significant perioperative advantages, such as reduced intraoperative blood loss, fewer postoperative complications, and a shorter hospital stay after surgery [1]. Zhiming Zhao and Zhuzeng Yin contributed equally to this work, and should be considered as first authors. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s13304-020-00906-3) contains supplementary material, which is available to authorized users. * Rong Liu [email protected] 1
The Second Department of Hepatopancreatobiliary Surgery, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
Department of Hepatobiliary Surgery, The Fourth Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
2
However, LH still has shortcomings, such as a two-dimensional visual field, lower degrees of freedom of the fixed equipment, increased hand trembling, and a long learning curve. Hence, extensive and difficult LH requires careful measures by experienced surgeons [2]. The da Vinci ro
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