Page 20 - World Journal of Laparoscopic Surgery

Michail A Kirmanidis, Christodoulos Keskinis
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search engines like PubMed, MEDLINE, and so forth. Ferrara et al mention that there are no differences
“Laparoscopic vs robotic colectomy” and “comparing between right, left, and rectal robotic colectomy and
laparoscopic with robotic colectomy” were the search respective laparoscopic procedures in terms of mentioned
keywords that were used to find the publications that parameters. In fact, RS shows larger number of harvested
would conduct our research, and publications until lymph nodes, while LS seems to have lower conversion
March of 2016 were included. Our review contains rate (7.1% for robotics and 3.4% for laparoscopy) and oper-
retrospective studies, comparative studies, and meta- ative time, but the results are not statistically significant. 2
analyses. Only papers relevant to the laparoscopic and
robotic colectomy have been taken into consideration in Comparison between RS and LS in the Field of
this review, focusing on the parameters mentioned above Left Colon and/or Rectal Resections
and also on the learning curve of young novice surgeons. A matched case–control study indicates that there are no
Articles which compared the two methods with a sepa- different short-term outcomes between the two methods
rate specific surgical procedure, such as right colectomy regarding left-sided and rectal resections. The EBL, the
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are included, and reviewed and articles which do not need for open conversion, complications (anastomotic
classify the procedures separately are reviewed as well. leakage, ileus, and wound infections), flatus passage,
Totally, 19 studies were reviewed. LOS, and the number of retrieved lymph nodes presented
At first, there were 56 articles related to our scien- no significant difference, except for the operative time
tific interest identified after a long database search, but which was significantly longer in the RS colectomy.
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10 of them were excluded after reading the abstract. On the contrary, a recent meta-analysis conducted by Sun
Twenty-one of the remaining 46 records were excluded et al shows that robotic low anterior resection (R-LAR)
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due to lack of full texts. Six more papers were excluded for rectal cancer is proven to be more beneficial for
because they mentioned the comparison between hybrid LOS, the conversion to open surgery, the circumferen-
robotic-assisted laparoscopy colectomy and conventional tial margin involvement, and the overall complications
colectomy. The rest 19 papers were assessed for eligibility, than the laparoscopic low anterior resection (L-LAR),
screened in detail, and included in our review. Retrospec- whereas there was no difference regarding the operative
tive comparative studies and meta-analyses are the major- time, the number of lymph nodes removed, and the return
ity of the articles in our review. More importance is given of bowel function. 25
to the findings of the meta-analyses due to their reliability.
Heterogeneity can be found in the literature whether or Comparison of RS with the LS in the Field
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not RS is indeed superior to LS in the colorectal field. of Right Colon Resections
Total operative time, estimated blood loss (EBL), conver-
sion to open procedure, length of hospital stay (LOS), Because robotic right colectomy (RRC) and laparoscopic
readmission rate, number of lymph nodes harvested, right colectomy (LRC) are less complicated as a surgical
time to return of bowel function, time of initiation of procedure than rectal resection due to the anatomy of the
soft diet, and perioperative complications are the main human body, there are fewer studies comparing these
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clinicopathologic and oncologic parameters that have two methods with right colectomy. We included three
been extensively assessed in our review (Flow Chart 1). meta-analyses in our research. 4,7,17 Cumulatively, these
three studies include 30 comparative studies, in which
1,322 patients underwent RRC and 4,185 were treated
Flow Chart 1: Literature research with LRC. The first one was recently conducted from the
Surgery Department of Sapienza University and com-
pared the indications, surgical and oncologic outcomes,
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and costs of RRC with the LRC ones. The EBL, the
conversion to open procedure, the number of retrieved
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lymph nodes were similar in both of them. Unimport-
ant statistical differences were presented regarding LOS
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and the overall complications. The RRC entails more
expenses than LRC, although the difference is still not
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statistically important. On the contrary, the second
meta-analysis which had the larger statistical sample
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was conducted by Trinh et al and yielded the following
outcomes. No significant difference was spotted regard-
ing the harvested lymph nodes, the bowl function, the
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