Page 41 - World Journal of Laparoscopic Surgery

Laparoscopic vs Robotic Approach for Rectal Cancer: A Meta-analysis
Table 1: Demographics lower conversion rate favoring robotics (p = 0.002) was also reported
Age-group Country in their study. 12
Study (years) Male Female of origin Shiomi et al. reported similar findings with a difference in the
overall complication rate favoring the robotic approach (p = 0.003),
Kim (2017) 14 48–71 52 21 South Korea but no significant difference was found in the major complication
Ahmed et al. (2017) 6 62–74 58 27 Portugal rate (grade ≥III) between the two groups (p = 0.19). 13
A systematic review of the other parameters, namely,
Colombo (2015) 15 35–85 42 18 France
intraoperative blood loss, readmissions, postoperative 30-day
Valverde et al. (2017) 9 55–75 45 20 France mortality, previous history of abdominal surgery, etc., showed no
Park (2010) 16 54–72 39 33 Korea significant difference.
To sum up everything that has been stated so far, the results
Lim (2016) 8 33–86 36 18 Korea of this study suggest that the rates of sphincter preservation,
ISR, and conversion were lower with the Robotic TMEs compared
In our study, we found that the RSP for the robotic approach to laparoscopic TMEs, while no significant difference was found
was higher compared to the laparoscopic approach, and the in the rate of major (grade ≥III) complications between the two
difference was found to be statistically significant [0.49 (0.28, groups.
0.84)] (p = 0.01). Similarly, the RIR with the robotic approach was
found to be significantly higher than the laparoscopic group [0.95 conclusIon
(0.91, 0.99)] (p = 0.007). This could be attributed to various factors Due to the limited availability of data, a statistical analysis could
such as (1) robotics offers 3D views, which allows for precise not be done for the overall survival rate and further investigation
dissections in a narrow surgical field such as the pelvis, (2) better in multicenter studies is proposed to gain a better insight into it.
freedom of movement due to the EndoWrist instruments which Furthermore, we would also like to suggest studies to look into
increase dexterity, and (3) Avoidance of physiological tremors and other parameters such as the surgeon’s physical and mental stress,
decreased fatigue for the operator compared to the laparoscopic tumor spillage, R0 resection rate, and overall patient satisfaction
approach. 6 rate between the two groups which could potentially influence the
Baek et al. in their study to determine the advantages of overall outcome of rectal cancer surgeries.
Robotic surgery found albeit no significant difference between the
robotic and laparoscopic groups with respect to operative time, orcId
operative outcome, and pathological outcome, they did conclude Aniket Agrawal https://orcid.org/0000-0002-2660-5118
that the robotic surgical approach may help overcome some of Gursev Sandlas https://orcid.org/0000-0003-4890-9080
the limitations of laparoscopy such as better surgical access to Charu Tiwari https://orcid.org/0000-0002-3100-7980
anatomically difficult areas such as the pelvis. 7 Sachit Anand https://orcid.org/0000-0002-0447-2350
Ahmed et al. also compared the RSP between the two
approaches and found that the robotic approach yielded a higher Anoli Agrawal https://orcid.org/0000-0003-1045-1377
RSP than the laparoscopic approach and the difference was Vivek Viswanathan https://orcid.org/0000-0001-8488-0145
statistically significant (p = 0.045) independent of the tumor level.
They also reported a significantly lower conversion rate (p = 0.043), references
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