Safety and efficacy of robot-assisted laparoscopic hysterectomy vs. traditional laparoscopic hysterectomy：a systematic review

Abstract:

Objective：To compare the safety and efficacy of robot-assisted laparoscopic hysterectomy and traditional laparoscopic hys－terectomy． Methods：Databases including Pubmed，Cochrane Library，EMBASE，Medline，Wanfang，CNKI and VIP were searched． Randomized controlled trials（RCTs） and non-randomized controlled trials（NRCTs） focusing the comparison between robot-assisted laparoscopic hysterectomy and traditional laparoscopic hysterectomy were collected． All the literatures retrieved were screened accord－ing to preset standards，and the patients were divided into robotic group and laparoscopic group． A Meta analysis on safety and efficacy of two kinds of hysterectomy was carried out using the RevMan 5.3 software． Categorical variables were presented by odds ratio（OR） and 95％confidence interval（95％CI），continuous variables were presented by weighted mean difference（WMD） and 95％ confidence interval（95％CI）． Results：5 RCTs and 26 NRCTs including 4 235 patients undergo hysterectomy were screened out and there were 1870 patients in the robotic group and 2 365 patients in the laparoscopic group. Meta analysis suggest that compared with conventional laparoscopic surgery，lower rate of perioperative period complication（OR=0．71，95%CI=0.57 to 0.89，Z=2.97，P=0.003），shorter length of hospital stay（WMD=-0．42，95%CI=-0.65 to -0.20，Z=3.67，P=0.000 2），less operative blood loss（WMD=-81.04，95%CI=-104.50 to -57.58，Z=6.77，P=0.000），lower rate of conver－sion to laparotomy（OR=0.38，95%CI=0.25 to 0.58，Z=4.60，P=0.000） were observed in the robotic group．There were no significant dif－ferences in operation time（WMD=15.38，95%CI=-4.48 to 35.23，Z=1.52，P=0.130） and the number of lymph node dissected[pelvic lymph node group（WMD=-1.09，95%CI=-2.61 to 0.43，Z=1.40，P=0.160）；perivascular lymph node group（WMD=-0．19，95%CI=-2.93 to 2.56，Z=0.13，P=0.890）] between two groups． Subgroup analysis suggest that the robotic group has less operative blood loss（WMD= -88.78，95%CI=-98.03 to -79.52，Z=18.80，P=0.000），there were significant differences between two groups. Conclusion：compared with conventional laparoscopic surgery，the robotic group has lower rate of perioperative period complication，shorter length of hospital stay，less operative blood loss（especially suitable for patients with small uterus），lower rate of conversion to laparotomy，However，there were no significant differences in operation time and the number of lymph node dissected. Whereas，considering the quality of the original literatures with obvious heterogeneity is not high，the present conclusions demonstrate strength is limited.