Page 21 - World Journal of Laparoscopic Surgery

WJOLS

Reviewing the Comparison of Robotic Colectomy with the Laparoscopic Ones
days to soft diet, the LOS, the hospital readmission, and Table 1: Presentation of each one of the three meta-analyses
4
the postoperative complications. Based on this meta- for every parameter
analysis, the robotic approach showed longer operating 1st Meta- 2nd Meta- 3rd Meta-
times, less EBL, and a higher rate of conversion to an open Parameters analysis analysis analysis
Operative time
Yes
Yes
Yes
7
4
procedure compared with that of LS. Xu et al considered EBL No Yes Yes
in their meta-analysis which showed that RRC involves Conversion to open procedure No Yes No
longer operative times, lower EBL, shorter LOS, lower Number of retrieved lymph No No NA
overall complications, and, importantly, faster bowel nodes
function recovery. The rest clinical and oncological results LOS No No Yes
seem to not have any statistical difference. 7 Overall complications No No Yes
26
A newly comparative study by Cardinali et al indi- Financial expenses No NA NA
cates that RRC appears to have some advantages over Bowel function NA No Yes
NA
NA
No
Days of soft diet
the LRC like the lower time of first flatus, but it does not Hospital readmission NA No NA
offer any benefit in obese patients due to the fact that Circumferential margin NA NA NA
both methods perform no significant difference in the involvement
conversion rate. Another comparative study points out The meta-analyses are numbered according to their order in
that the RS could also shorten the learning curve, in case the text; NA: Not applicable
the respective strict protocols are applied. 1
it easier to avoid the trauma to the nerves related to the
27
DISCuSSIOn sexual and urinary functions. Fabrizio Luca presented a
paper in the 5th Congress of the Clinical Robotic Surgery
In the field of colorectal cancer, LS and RS are both Association (CRSA) and mentioned that RS can enhance
considered almost equally safe and effective methods, the nerve-sparing results of total mesorectal excision
proving that radical prostatectomy was only the begin- related to LS method regardless of the gender. However,
28
ning of consolidation of RS and the use of RS can be during the paper’s discussion some doubts were posed
more widespread. 3,7,17,24,26 Our research focuses on the about the preoperative reliability of the evaluation of
conventional laparoscopy and the RS as separate sur- these specific functions (urinary and sexual), so that they
gical methods and does not include their hybrid use. become more standardized in the future.
The confirmation of the existing heterogeneity between Undoubtedly, right colectomy is a less complicated
these two new surgical methods involves our reviewed procedure than rectal resection, but the use of both RS
parameters along with the clinicopathological, onco- and LS has also been reviewed thoroughly. Two of the
logical, and financial ones. The accurate choice of these three recent meta-analyses concluded that there are some
criteria was accomplished after a careful, long research statistical differences between the RRC and the LRC in
via recent meta-analyses, control and statistically reliable some of our parameters. Both studies agree that RRC is
comparative studies. 1,3,7,16,17,20,25 Mainly, meta-analyses a longer procedure than LRC and that the EBL is less in
were reviewed due to their credibility compared with the RRC. Huirong Xu et al deem that LOS, the overall
7
other studies, which are reviewed and included in our complications, and the bowel function differ between
manuscript. More specifically, the criteria are presented the two methods in an important way, whereas the other
in Table 1, but the research contains the rectal and left- respective meta-analysis’ results are considered controver-
sided colon resections as well. sial. The results of these three meta-analyses are summa-
Pelvis is the anatomical section of the human body rized in Table 1 and the “YES” and “NO” are used as the
where RS can be applied with its maximum benefits answers to the question: “Is there a statistically significant
according to its adopters, but controversial studies’ result between the RRC and LRC regarding to a specific
results came up through our research. Studies which parameter each time?” while the choice “not available
did not end up with this conclusion were reviewed, but (NA)” is used for whether or not in this particular meta-
the most statistically reliable meta-analysis, the one by analysis the mentioned appearing parameter is included.
25
Sun et al, clarifies the advantages of R-LAR over L-LAR In the CRSA Fifth Worldwide Congress in Washington
for the LOS as mentioned earlier. Another randomized DC from 3 to 5 October 2013, a controlled randomized
controlled study is in favor of the adoption of RS in rectal trial ended up with the conclusion that RRC has no sig-
surgery, but tempers the encouraging conclusion from the nificant difference with the LRC and due to its expenses
3
former meta-analysis. The main reason why RS seems to it should not be frequently used. 28
be a more promising tool in the pelvis is because of the The intro of a learner in the MIS can be easier for the
absence of the tremor, which implies less EBL and makes RRC than LRC in a specific center with rigorous protocols,
World Journal of Laparoscopic Surgery, May-August 2017;10(2):61-65 63