Table_1_Comparison of Robotic-Assisted vs. Conventional Laparoscopy for Para-aortic Lymphadenectomy in Gynecological Malignancies: A Systematic Review and Meta-Analysis.DOCX

BackgroundRobotic-assisted surgery is one of the novel minimally invasive surgical techniques for the treatment of gynecological malignancies. The aim of this systematic review and meta-analysis was to compare the outcomes of robot-assisted vs. conventional laparoscopy for para-aortic lymphadenectomy (PAL) in patients with gynecological malignancies.MethodsAn electronic search in PubMed, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar databases was performed for articles, published up to 01st November 2021. Outcomes including operating time (OT), total blood loss (TBL), length of stay (LOS), and complication rate (CR) in robot-assisted vs. conventional laparoscopy were investigated.ResultsA total of nine studies (7 non-RCTs and 2 RCTs) involving 914 participants were included. Of them, 332 patients underwent robotic laparoscopy (robotic group) and 582-conventional laparoscopy (conventional laparoscopy group). A significant decrease in TBL (MD = −149.1; 95% CI: −218.4 to −79.91) [ml] was observed in the robotic group as compared to the conventional laparoscopy group. However, no significant difference was noted for OT, CR, and LOS in the overall findings. Further subgroup analysis showed that the robotic group had a lower OT in mixed histological populations and studies reporting on the extraperitoneal approach. The lower chance of TBL was observed in mixed histological populations and studies involving extraperitoneal approach, Caucasian population, and non-RCTs design.ConclusionsRobotic laparoscopy has a significant advantage over the conventional laparoscopy approach for PAL in gynecological malignancies. Further prospective observational studies embedded with a large sample size are needed to validate our findings.

背景：机器人辅助手术是治疗妇科恶性肿瘤的一种新型微创外科技术。本系统性综述和荟萃分析旨在比较机器人辅助手术与常规腹腔镜手术在妇科恶性肿瘤患者中进行骶主动脉淋巴结清扫术（PAL）的结果。方法：对PubMed、Scopus、Cochrane中央对照试验注册库（CENTRAL）和Google Scholar数据库进行了电子检索，检索至2021年11月1日前的相关文献。研究了机器人辅助手术与常规腹腔镜手术在手术时间（OT）、总失血量（TBL）、住院时间（LOS）和并发症发生率（CR）方面的差异。结果：共纳入9项研究（7项非随机对照试验和2项随机对照试验），涉及914名参与者。与常规腹腔镜手术组相比，机器人辅助手术组TBL显著降低（MD = −149.1；95% CI: −218.4至−79.91 [ml]）。然而，在总体结果中，OT、CR和LOS方面没有观察到显著差异。进一步亚组分析显示，在混合组织学人群和报道外腹膜途径的研究中，机器人辅助手术组的手术时间较短。在混合组织学人群、涉及外腹膜途径、高加索人群和非随机对照试验设计中，TBL较低。结论：机器人腹腔镜手术在妇科恶性肿瘤进行PAL方面相较于常规腹腔镜手术具有显著优势。需要进一步的前瞻性观察性研究，并纳入大量样本以验证我们的发现。