Cargando…
Robotic-assisted benign hysterectomy compared with laparoscopic, vaginal, and open surgery: a systematic review and meta-analysis
The potential benefits and limitations of benign hysterectomy surgical approaches are still debated. We aimed at evaluating any differences with a systematic review and meta-analysis. PubMed, MEDLINE, and EMBASE databases were last searched on 6/2/2021 to identify English randomized controlled trial...
Autores principales: | , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer London
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10678826/ https://www.ncbi.nlm.nih.gov/pubmed/37856058 http://dx.doi.org/10.1007/s11701-023-01724-6 |
_version_ | 1785141973878833152 |
---|---|
author | Lenfant, Louis Canlorbe, Geoffroy Belghiti, Jérémie Kreaden, Usha Seshadri Hebert, April E. Nikpayam, Marianne Uzan, Catherine Azaïs, Henri |
author_facet | Lenfant, Louis Canlorbe, Geoffroy Belghiti, Jérémie Kreaden, Usha Seshadri Hebert, April E. Nikpayam, Marianne Uzan, Catherine Azaïs, Henri |
author_sort | Lenfant, Louis |
collection | PubMed |
description | The potential benefits and limitations of benign hysterectomy surgical approaches are still debated. We aimed at evaluating any differences with a systematic review and meta-analysis. PubMed, MEDLINE, and EMBASE databases were last searched on 6/2/2021 to identify English randomized controlled trials (RCTs), prospective cohort and retrospective independent database studies published between Jan 1, 2010 and Dec 31, 2020 reporting perioperative outcomes following robotic hysterectomy versus laparoscopic, open, or vaginal approach (PROSPERO #CRD42022352718). Twenty-four articles were included that reported on 110,306 robotic, 262,715 laparoscopic, 189,237 vaginal, and 554,407 open patients. The robotic approach was associated with a shorter hospital stay (p < 0.00001), less blood loss (p = 0.009), and fewer complications (OR: 0.42 [0.27, 0.66], p = 0.0001) when compared to the open approach. The main benefit compared to the laparoscopic and vaginal approaches was a shorter hospital (R/L WMD: – 0.144 [– 0.21, – 0.08], p < 0.0001; R/V WMD: – 0.39 [– 0.70, – 0.08], p = 0.01). Other benefits seen were sensitive to the inclusion of database studies. Study type differences in outcomes, a lack of RCTs for robotic vs. open comparisons, learning curve issues, and limited robotic vs. vaginal publications are limitations. While the robotic approach was mainly comparable to the laparoscopic approach, this meta-analysis confirms the classic benefits of minimally invasive surgery when comparing robotic hysterectomy to open surgery. We also reported the advantages of robotic surgery over vaginal surgery in a patient population with a higher incidence of large uterus and prior surgery. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11701-023-01724-6. |
format | Online Article Text |
id | pubmed-10678826 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Springer London |
record_format | MEDLINE/PubMed |
spelling | pubmed-106788262023-10-19 Robotic-assisted benign hysterectomy compared with laparoscopic, vaginal, and open surgery: a systematic review and meta-analysis Lenfant, Louis Canlorbe, Geoffroy Belghiti, Jérémie Kreaden, Usha Seshadri Hebert, April E. Nikpayam, Marianne Uzan, Catherine Azaïs, Henri J Robot Surg Review The potential benefits and limitations of benign hysterectomy surgical approaches are still debated. We aimed at evaluating any differences with a systematic review and meta-analysis. PubMed, MEDLINE, and EMBASE databases were last searched on 6/2/2021 to identify English randomized controlled trials (RCTs), prospective cohort and retrospective independent database studies published between Jan 1, 2010 and Dec 31, 2020 reporting perioperative outcomes following robotic hysterectomy versus laparoscopic, open, or vaginal approach (PROSPERO #CRD42022352718). Twenty-four articles were included that reported on 110,306 robotic, 262,715 laparoscopic, 189,237 vaginal, and 554,407 open patients. The robotic approach was associated with a shorter hospital stay (p < 0.00001), less blood loss (p = 0.009), and fewer complications (OR: 0.42 [0.27, 0.66], p = 0.0001) when compared to the open approach. The main benefit compared to the laparoscopic and vaginal approaches was a shorter hospital (R/L WMD: – 0.144 [– 0.21, – 0.08], p < 0.0001; R/V WMD: – 0.39 [– 0.70, – 0.08], p = 0.01). Other benefits seen were sensitive to the inclusion of database studies. Study type differences in outcomes, a lack of RCTs for robotic vs. open comparisons, learning curve issues, and limited robotic vs. vaginal publications are limitations. While the robotic approach was mainly comparable to the laparoscopic approach, this meta-analysis confirms the classic benefits of minimally invasive surgery when comparing robotic hysterectomy to open surgery. We also reported the advantages of robotic surgery over vaginal surgery in a patient population with a higher incidence of large uterus and prior surgery. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11701-023-01724-6. Springer London 2023-10-19 2023 /pmc/articles/PMC10678826/ /pubmed/37856058 http://dx.doi.org/10.1007/s11701-023-01724-6 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Review Lenfant, Louis Canlorbe, Geoffroy Belghiti, Jérémie Kreaden, Usha Seshadri Hebert, April E. Nikpayam, Marianne Uzan, Catherine Azaïs, Henri Robotic-assisted benign hysterectomy compared with laparoscopic, vaginal, and open surgery: a systematic review and meta-analysis |
title | Robotic-assisted benign hysterectomy compared with laparoscopic, vaginal, and open surgery: a systematic review and meta-analysis |
title_full | Robotic-assisted benign hysterectomy compared with laparoscopic, vaginal, and open surgery: a systematic review and meta-analysis |
title_fullStr | Robotic-assisted benign hysterectomy compared with laparoscopic, vaginal, and open surgery: a systematic review and meta-analysis |
title_full_unstemmed | Robotic-assisted benign hysterectomy compared with laparoscopic, vaginal, and open surgery: a systematic review and meta-analysis |
title_short | Robotic-assisted benign hysterectomy compared with laparoscopic, vaginal, and open surgery: a systematic review and meta-analysis |
title_sort | robotic-assisted benign hysterectomy compared with laparoscopic, vaginal, and open surgery: a systematic review and meta-analysis |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10678826/ https://www.ncbi.nlm.nih.gov/pubmed/37856058 http://dx.doi.org/10.1007/s11701-023-01724-6 |
work_keys_str_mv | AT lenfantlouis roboticassistedbenignhysterectomycomparedwithlaparoscopicvaginalandopensurgeryasystematicreviewandmetaanalysis AT canlorbegeoffroy roboticassistedbenignhysterectomycomparedwithlaparoscopicvaginalandopensurgeryasystematicreviewandmetaanalysis AT belghitijeremie roboticassistedbenignhysterectomycomparedwithlaparoscopicvaginalandopensurgeryasystematicreviewandmetaanalysis AT kreadenushaseshadri roboticassistedbenignhysterectomycomparedwithlaparoscopicvaginalandopensurgeryasystematicreviewandmetaanalysis AT hebertaprile roboticassistedbenignhysterectomycomparedwithlaparoscopicvaginalandopensurgeryasystematicreviewandmetaanalysis AT nikpayammarianne roboticassistedbenignhysterectomycomparedwithlaparoscopicvaginalandopensurgeryasystematicreviewandmetaanalysis AT uzancatherine roboticassistedbenignhysterectomycomparedwithlaparoscopicvaginalandopensurgeryasystematicreviewandmetaanalysis AT azaishenri roboticassistedbenignhysterectomycomparedwithlaparoscopicvaginalandopensurgeryasystematicreviewandmetaanalysis |