Effectiveness And Safety Of Da Vinci-assisted Versus Laparoscopic Hepatectomy:A Meta-analysis

Objective:Robot-assisted hepatectomy is a minimally invasive technique that has emerged in recent years,but there is no definitive evidence to prove which is more advantageous in terms of effectiveness and safety compare with traditional laparoscopic hepatectomy;This study compared the effectiveness and safety of robotic liver resection(RLR)and laparoscopic liver resection(LLR)in the treatment of liver disease by meta-analysis.Methods:System search for commonly used databases such as Pubmed?Cochrane?CNKI,search for studies comparing RLR with LLR,the search time is from the establishment of the library to November 26,2018.Two independent researchers,based on inclusion and exclusion criteria,read the literature topics?abstracts and full texts to screening documents that meet the criteria.Using Newcastle-Ottawa Scale to assess quality of included studies and statistical analysis including literatures by Rev Man5.3 software.The analysis results determine the heterogeneity according to the Q test and the I2 statistic,and select the fixed or random effect model accordingly.The data of dichotomous variables were expressed as odds ratio(OR)and 95% CI,continuous variables were expressed as mean difference(MD)and 95% CI.Outcome include:Length of surgery?Conversion rate?Blood loss?Transfusion rate?Complication rate?Bile leakage rate?Malignancy R0 resection rate?Length of stay?Tumor size.Results: There were 19 eligible studies,of which 564 were in the RLR group and 875 were in the LLR group.Meta-analysis results show: Compared with LLR,RLR had longer operation time[MD=46.87,95%CI(28.05,65.68),P<0.00001] and larger tumor size[MD=0.30,95%CI(0.08,0.51),P=0.006],and it has a significant advantage over the LLR group in Malignancy R0 resection rate,but there were no significant differences in Conversion rate?Blood loss?Transfusion rate?Complication rate?Bile leakage rate and Length of stay.Conclusion:Current evidence shows that robotic hepatectomy has similar safety and efficacy to laparoscopic liver resection,and it has a higher R0 resection rate for malignant tumors,so it is safe and feasible to process robotic hepatectomy in accordance with the indications especially for malignant tumors.Compared with traditional laparoscopic surgery,robotic hepatectomy has a longer operation time,but there is a significant advantage in the R0 resection rate of malignant tumors,and there is no significant difference in other outcome indicators.According to the research results,this may be related to the larger tumor and more difficult surgery in the robot group.It is believed that with the development of equipment and technology,the robotic surgery system will gradually reflect its unique advantages.Subject to the quality of the literature and the differences in evaluation methods between studies,more prospective randomized controlled trial,more diverse hepatectomy,and longer follow-up are needed in the future to accurately compare robotic liver resection and laparoscopic liver resection.