Clinical efficacy and safety of robot assisted surgery for choledochal cysts excisions: a systematic review and meta-analysis

This study aimed to evaluate the safety and therapeutic effect of Robot-assisted surgery (RAS) for choledochal cysts (CCs) excisions. PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, WanFang, VIP, and CBM were searched from database inception to 1 May 2022. The Newcastle-Ottawa scale (NOS) was used to conduct quality assessments, and RevMan (Version 5.4) was used to perform the meta-analysis. In all, 9 studies, involving 623 patients, were analyzed. RAS compared with LAS was associated with less intraoperative blood loss, shorter time to start solid diets, shorter postoperative hospital stay, and lower complications. There was no significant difference in operative time between the two groups, but the total costs were higher in RAS. Our subgroup analysis showed that RAS had significant advantages over LAS in the child group: minor bleeding, shorter length of hospital stay, and fewer postoperative complications. The available evidence indicates that the RAS system has the advantages of less intraoperative blood loss, minor tissue damage, quick recovery, and sound healing in treating choledochal cyst, which proves that the RAS is safely feasible. Especially in children, RAS tends to be a better choice.

本研究旨在评估机器人辅助手术（Robot-assisted surgery, RAS）用于胆总管囊肿（choledochal cysts, CCs）切除术的安全性与治疗效果。检索了PubMed、EMBASE、Cochrane Library、Web of Science、中国知网（CNKI）、万方数据、维普资讯以及中国生物医学文献数据库（CBM）自建库至2022年5月1日的相关文献。采用纽卡斯尔-渥太华量表（Newcastle-Ottawa scale, NOS）进行质量评价，并使用RevMan（版本5.4）开展Meta分析。最终纳入9项研究，共涉及623例患者进行分析。相较于腹腔镜辅助手术（LAS），机器人辅助手术的术中失血量更少、开始固体饮食的时间更短、术后住院时长更短且并发症发生率更低。两组手术时间无显著差异，但机器人辅助手术的总费用更高。亚组分析结果显示，在儿童群体中，机器人辅助手术相较于腹腔镜辅助手术具有显著优势：术中出血量更少、住院时长更短以及术后并发症更少。现有证据表明，机器人辅助手术系统在治疗胆总管囊肿时，具备术中失血量少、组织损伤轻、恢复快且愈合效果佳的优势，证实其安全可行。尤其在儿童患者中，机器人辅助手术堪称更优选择。