Robot-assisted Versus Conventional Laparoscopic Operation In Pancreatectomy:A Meta-analysis

Objective: Meta-analysis was used to evaluate the clinical efficacy and feasibility of two surgical interventions by searching the original controlled study of Da Vinci robot versus laparoscopic short-term efficacy of pancreatectomy.Methods: The literatures on Da Vinci robots and laparoscopy for pancreatectomy were searched in various databases at home and abroad.The database includes 4 Chinese databases(China Knowledge Network,Wanfang Database,China Biomedical Literature Database,and the full text of scientific journals).Database)and English database 3(EMBASE,the Cochrane Library and PubMed);search deadline to April 2018.Search using the subject words plus free words,the search strategy words are as follows: English search term 1.Pancreas OR Pancreatectomy OR Pancreaticojejunostomy;2.Robotics OR Soft Robotics OR Robotic,Soft OR Remote Operations(Robotics)OR Robot assisted OR Telerobotics;3.Laparoscopy OR Celioscopy OR Surgical Procedures,Laparoscopic OR Surgery,Laparoscopic OR Surgery,Laparoscopic Assisted OR Laparoscopic Surgery.Chinese search term: Pancreatectomy,robotic surgery,and laparoscopic surgery.Observed indicators were selected as: Operation Time(OT),Volume of intraoperative bleeding(VIB),Hospitalization time(HT),spleen preserving(SP),Open conversion(OC),overall complications(OCs)and overall pancreatic fistulas(OPFs).Set the inclusion and exclusion labels,and finally extract the qualified data for the Meta-analysis using the review software version 5.3 statistical software.Results: A total of 11 original studies meeting the inclusion and exclusion criteria were retrieved,with a total of 600 subjects,including 229 in the Da Vinci robot group and 371 in the laparoscopic group.Compared with the laparoscopic group,the Da Vinci robotic group had a longer operation time in the pancreatectomy than in the laparoscopic group(MD = 32.25;95% CI: [4.71,59.78];P = 0.02);volume of intraoperative bleeding was less than the laparoscopic group(MD =-149.95;95% CI: [-287.38,-12.51];P = 0.03);postoperative hospitalization time was shorter than laparoscopic group(MD =-2.47;95% CI: [-4.23,-0.71 ];P = 0.006);there were no significant differences between the remaining indicators: spleen preserving(MD = 1.38;95% CI: [0.86,2.23];P = 0.18);open conversion(MD = 0.78;95%)CI: [0.45,1.36];P = 0.38);overall complications(MD = 0.92;95% CI: [0.61,1.38];P = 0.68);overall pancreatic fistulas(MD = 0.93;95%)CI: [0.56,1.55];P = 0.79).Conclusion: Compared with laparoscopic surgery,Da Vinci robotic pancreatectomy can reduce the volume of bleeding and shorten the postoperative hospitalization time,but the operation time is longer than the laparoscopic group;the open conversion,complications,pancreatic fistulas and spleen preserving are comparable.The Da Vinci robotic surgery system is an effective and viable alternative to laparoscopic surgery for pancreatic resection.