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中华疝和腹壁外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (05) : 588 -598. doi: 10.3877/cma.j.issn.1674-392X.2024.05.023

循证医学

机器人对比腹腔镜及开放式腹股沟疝修补术的Meta 分析
孙昭1, 刘琪1, 王殿琛1, 姜建武1, 符洋1,†()   
  1. 1.450052 郑州大学第一附属医院疝与腹壁外科
  • 收稿日期:2024-08-06 出版日期:2024-10-18
  • 通信作者: 符洋
  • 基金资助:
    河南省高等学校重点科研项目计划（22A320053）吴阶平医学基金会临床科研专项资助基金（320.6750.2022-7-9）

A meta-analysis of robotic versus laparoscopic and open inguinal hernia repair

Zhao Sun1, Qi Liu1, Dianchen Wang1, Jianwu Jiang1, Yang Fu1,†()   

  1. 1.Department of Hernia and Abdominal Wall Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
  • Received:2024-08-06 Published:2024-10-18
  • Corresponding author: Yang Fu
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引用本文：

孙昭, 刘琪, 王殿琛, 姜建武, 符洋. 机器人对比腹腔镜及开放式腹股沟疝修补术的Meta 分析[J]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 588-598.

Zhao Sun, Qi Liu, Dianchen Wang, Jianwu Jiang, Yang Fu. A meta-analysis of robotic versus laparoscopic and open inguinal hernia repair[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(05): 588-598.

目的

系统评价机器人对比腹腔镜及开放式腹股沟疝修补术的安全性与有效性。

方法

检索Cochrane Library、PubMed、MEDLINE、Web of Science 核心合集以及知网与万方数据库中发表的2000 年1 月至2024 年7 月的临床对照研究，并按照纳入排除标准进行筛选。2 名独立研究人员使用纽卡斯尔-渥太华量表（NOS）或Jadad 量表进行文献质量评价并随后进行数据提取。使用R 中“meta”包（V6.0.0）进行数据分析。

结果

最终纳入26 项研究进行数据整合，共计17 354例患者，其中机器人腹股沟疝修补术4813 例，开放式手术5870 例、腹腔镜手术6671 例。机器人手术的术后并发症发生率、复发率、再入院率、血肿发生率与开放式手术及腹腔镜手术相比，差异均无统计学意义（P＞0.05）。但机器人手术组平均手术时间更长、住院费用更高[机器人比腹腔镜SMD=22.40，95% CI（15.43～29.37），P＜0.01；机器人比开放式SMD=1.19，95% CI（0.71～1.68），P＜0.01]。机器人手术的住院时间较开放式手术更短[SMD=－0.47，95% CI（－0.84～－0.09），P=0.01]，但与腹腔镜手术比较，差异无统计学意义[SMD=0.17，95% CI（－0.07～0.40），P=0.16]。此外，机器人手术的疼痛率较腹腔镜手术低，差异有统计学意义[OR=0.50，95% CI（0.25～1.01），P=0.05]。

结论

机器人腹股沟疝修补术是一种安全有效的手术方式，其住院时间较开放手术、疼痛率较腹腔镜手术具有一定优势，但仍需进一步研究证实。

关键词: 疝, 腹股沟, 疝修补术, 机器人手术, 荟萃分析, 并发症

Objective

To systematically evaluate the safety and efficacy of robotic surgery compared to laparoscopic and open inguinal hernia repair.

Methods

A comprehensive search was conducted in the Cochrane Library, PubMed, MEDLINE, Web of Science Core Collection, CNKI and Wanfang databases for clinical controlled trials published from January 2000 to July 2024. Studies were screened based on predefined inclusion and exclusion criteria. Two independent researchers assessed the quality of the literature using the Newcastle-Ottawa Scale (NOS) or the Jadad scale, and conducted the subsequent data extraction. Data analysis was performed using the “meta” package (version 6.0.0) in R.

Results

A total of 26 studies were included in the data analysis, including 17 354 patients: 4813 underwent robotic inguinal hernia repair, 5870 underwent open surgery, and 6671 underwent laparoscopic surgery. Compared to open and laparoscopic surgeries, robotic surgery showed no significant differences in postoperative complication rate, recurrence rate, readmission rate, or hematoma occurrence (All P values＞0.05). However, the robotic surgery group exhibited longer operative times and higher costs[Robotic vs Laparoscopic: SMD=22.40, 95% CI (15.43-29.37), P＜0.01; Robotic vs Open: SMD=1.19, 95%CI (0.71-1.68), P＜0.01]. In comparison to open surgery, robotic surgery had shorter hospital stays[SMD=-0.47, 95% CI (-0.84--0.09), P=0.01], but there was no statistically significant difference when compared to laparoscopic surgery [SMD=0.17, 95% CI (-0.07-0.40), P=0.16]. Additionally, robotic surgery demonstrated a significant lower pain rate compared to laparoscopic surgery [OR=0.50, 95% CI(0.25-1.01), P=0.05].

Conclusion

Robotic inguinal hernia repair is a safe and effective surgical approach. Its advantages in terms of hospital stay compared to open surgery and pain rates compared to laparoscopic surgery warrant further investigation to confirm.

Key words: Hernia, inguinal, Herniorrhaphy, Robotic surgery, Meta-analysis, Complications
图1 文献筛选流程图及结果
图2 机器人与腹腔镜、开放式腹股沟疝修补术总并发症发生率比较
图3 机器人与腹腔镜、开放式腹股沟疝修补术复发率比较
表1 纳入研究的特征与质量评价
第一作者/发表时间 国家和地区 试验设计 手术方式 例数 结局指标 质量评价
Ayuso 2023[14] 美国 RSC+PSM R/L 141/141 1,2,3,6,7 7
Abdelmoaty 2019[23] 美国 RSC R/L 734/1671 3 6
Aghayeva 2020[24] 土耳其 RSC+PSM R/L 43/43 1,2,4,7,6,8 8
Bittner 2018[25] 美国 RSC+PSM R/L/O (83/85)/83/85 8 7
Chao 2024[26] 中国台湾 RMC R/L 279/763 1,2,5,6,7 7
Charles 2018[27] 美国 RSC R/L/O 69/241/191 1,3,5,6,7 5
Choi 2023[28] 韩国 RSC R/L 50/50 1,2,3,4,6,7 7
Ephraim 2022[29] 以色列 RSC R/L 80/108 1,4,6,7,8 6
Gamagami 2018[30] 美国 RMC+PSM R/O 444/444 1,2,5,6,8 7
Gerdes 2022[31] 瑞士 PSC R/L 29/29 5,6 6
Glasgow 2021[32] 美国 RMC R/L/O 100/100/100 1,3 5
Gundogdu 2020[33] 土耳其 RSC R/L 16/33 1,2,4,5,7 5
Holleran 2022[34] 美国 RMC R/L/O 6063/18 035/100 800 1,2,5 5
Hsu 2023[35] 美国 RSC R/L/O 207/305/194 1,4,5,7,8 7
Huerta 2019[36] 美国 RSC R/L/O 71/128/1100 1.2.4,5.7.8 6
Kakiashvili 2021[37] 以色列 RSC R/L/O 24/16/97 1 4
Khoraki 2020[38] 美国 RSC R/L 45/138 1,2,3,4,5,6,7 5
Kolachalam 2018[39] 美国 RMC+PSM R/O 95/93 1,2,5,6 6
Kosturakis 2018[40] 美国 RSC R/O 100/100 1,7,8 6
Kudsi 2023[41] 美国 RSC R/L 547/606 1,4,7 7
Kudsi 2017[42] 美国 RSC R/L 118/157 1,4,5,6,8 8
LeBlanc 2020[43] 美国 PMC+PSM R/L/O (80/112)/80/112 1,5,6 7
Muysoms 2018[44] 比利时 PSC R/L 49/64 1,2,4,5 7
Muysoms 2021[45] 比利时 PSC R/L 404/272 1,2,3,4,5,6 7
Okamoto 2023[46] 日本 RSC+PSM R/L 80/80 1,4,7,8 7
Peltrini 2023[47] 意大利 RMC+PSM R/L 40/80 1,2,4,5,6,7,8 7
Pokala 2019[48] 美国 RMC R/L/O 594/540/2413 2,3,5,6 6
Prabhu 2020[49] 美国 RCT R/L 48/54 1,3,6 5
Tonelli 2022[50] 美国 RSC+PSM R/L/O 342/1026/1026 1,5 8
Waite 2016[51] 美国 RSC R/L 39/24 1,2,3,8 5
图4 机器人与腹腔镜、开放式腹股沟疝修补术的手术时间比较
图5 机器人与腹腔镜、开放式腹股沟疝修补术住院时间比较
图6 机器人与腹腔镜、开放式腹股沟疝修补术疼痛率比较
图7 机器人与腹腔镜、开放式腹股沟疝修补术血肿发生率比较
图8 机器人与腹腔镜、开放式腹股沟疝修补术再入院率比较
图9 机器人与腹腔镜腹股沟疝修补术住院费用比较
表2 发表偏倚Egger 检验结果
指标 组别 t值 P值 tau ^2
手术时间 R/L 1.07 0.2987 18.825
手术时间 R/O -0.42 0.6818 102.878
住院时间 R/L 1.64 0.1531 5.749
总并发症发生率 R/L 0.63 0.5437 2.417
总并发症发生率 R/O 0.62 0.5559 10.504
血肿发生率 R/L -0.30 0.7733 0.937
再入院率 R/L 2.82 0.0303 1.500
复发率 R/L 1.06 0.3231 1.325
[1]
Ma Q, Jing W, Liu X, et al. The global, regional, and national burden and its trends of inguinal, femoral, and abdominal hernia from 1990 to 2019: findings from the 2019 Global Burden of Disease Study-a cross-sectional study[J]. Int J Surg, 2023, 109(3): 333-342.
[2]
Bullen NL, Massey LH, Antoniou SA, et al. Open versus laparoscopic mesh repair of primary unilateral uncomplicated inguinal hernia: a systematic review with meta-analysis and trial sequential analysis[J]. Hernia, 2019, 23(3): 461-472.
[3]
Defnet AM, Davis SS Jr. The Robot in General Surgery-Change Is the Only Constant[J]. JAMA Surg, 2021, 156(1): 30.
[4]
贾卓奇, 周维茹, 张勇, 等. 达·芬奇机器人与腹腔镜食管裂孔疝修补术的对比研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2023,17(4): 410-414.
[5]
Rivero-Moreno Y, Echevarria S, Vidal-Valderrama C, et al. Robotic Surgery: A Comprehensive Review of the Literature and Current Trends[J]. Cureus, 2023, 15(7): e42370.
[6]
吴少峰, 张轶男, 孙杰. 机器人辅助手术在儿童微创泌尿手术中的应用和展望[J/OL]. 中华腔镜泌尿外科杂志（电子版）, 2023,17(5): 440-444.
[7]
郝超, 黄骥, 吴高亮, 等. 机器人辅助腹腔镜体内原位U 形回肠新膀胱术的临床疗效观察及尿动力分析[J/OL]. 中华腔镜泌尿外科杂志（电子版）, 2023, 17(1): 11-15.
[8]
胡博文, 戴英波. 泌尿外科机器人手术新趋势[J/OL]. 中华腔镜泌尿外科杂志（电子版）, 2023, 17(4): 418-421.
[9]
梅津熠, 王燕, 瞿旻, 等. 机器人前列腺癌根治术中"膀胱外中叶"的处理[J/OL]. 中华腔镜泌尿外科杂志（电子版）, 2023, 17(5):429-433.
[10]
狄金明, 黄展森, 吴杰英, 等. 机器人辅助腹腔镜下左肾静脉移位术治疗胡桃夹综合征[J/OL]. 中华腔镜泌尿外科杂志（电子版）,2022, 16(4): 373-374.
[11]
Galvani CA, Loebl H, Osuchukwu O, et al. Robotic-Assisted Paraesophageal Hernia Repair: Initial Experience at a Single Institution[J]. J Laparoendosc Adv Surg Tech A, 2016, 26(4): 290-295.
[12]
Gu L, Yin C, Jia T, et al. Robotic surgery in China[J]. Innovation(Camb), 2023, 4(5): 100499.
[13]
Vasudevan V, Reusche R, Nelson E, et al. Robotic paraesophageal hernia repair: a single-center experience and systematic review[J]. J Robot Surg, 2018, 12(1): 81-86.
[14]
Ayuso SA, Marturano MN, Katzen MM, et al. Laparoscopic versus robotic inguinal hernia repair: a single-center case-matched study[J].Surg Endosc, 2023, 37(1): 631-637.
[15]
Li X, Li YJ, Dong H, et al. Meta-analysis of the effectiveness and safety of robotic-assisted versus laparoscopic transabdominal preperitoneal repair for inguinal hernia[J]. PLoS One, 2024, 19(2): e0298989.
[16]
De'angelis N, Schena CA, Moszkowicz D, et al. Robotic surgery for inguinal and ventral hernia repair: a systematic review and meta-analysis[J]. Surg Endosc, 2024, 38(1): 24-46.
[17]
Page MJ, Mckenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews[J].Bmj, 2021, 372: n71.
[18]
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses[J]. Eur J Epidemiol, 2010, 25(9): 603-605.
[19]
Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?[J].Control Clin Trials, 1996, 17(1): 1-12.
[20]
Wan X, Wang W, Liu J, et al. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range[J]. BMC Med Res Methodol, 2014, 14: 135.
[21]
Woolson RF, Bean JA. Mantel-Haenszel statistics and direct standardization[J]. Stat Med, 1982, 1(1): 37-39.
[22]
Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test[J]. BMJ, 1997, 315(7109): 629-634.
[23]
Abdelmoaty WF, Dunst CM, Neighorn C, et al. Robotic-assisted versus laparoscopic unilateral inguinal hernia repair: a comprehensive cost analysis[J]. Surg Endosc, 2019, 33(10): 3436-3443.
[24]
Aghayeva A, Benlice C, Bilgin IA, et al. Laparoscopic totally extraperitoneal vs robotic transabdominal preperitoneal inguinal hernia repair: Assessment of short- and long-term outcomes[J]. Int J Med Robot, 2020, 16(4): e2111.
[25]
Bittner Iv JG, Cesnik LW, Kirwan T, et al. Patient perceptions of acute pain and activity disruption following inguinal hernia repair: a propensity-matched comparison of robotic-assisted, laparoscopic,and open approaches[J]. J Robot Surg, 2018, 12(4): 625-632.
[26]
Chao TC, Tung HY, Tsai CH, et al. Laparoscopic versus robotic TAPP/TEP inguinal hernia repair: a multicenter, propensity score weighted study[J]. Hernia, 2024, 28(1): 199-209.
[27]
Charles EJ, Mehaffey JH, Tache-Leon CA, et al. Inguinal hernia repair: is there a benefit to using the robot?[J]. Surg Endosc, 2018,32(4): 2131-2136.
[28]
Choi YS, Kim KD, Choi MS, et al. Initial Experience of Robot-Assisted Transabdominal Preperitoneal(TAPP) Inguinal Hernia Repair by a Single Surgeon in South Korea[J]. Medicina(Kaunas), 2023, 59(3): 582.
[29]
Ephraim K, Haggai B, Mohammad A, et al. Learning curve of robotic inguinal hernia repair in the hands of an experienced laparoscopic surgeon: a comparative study[J]. J Robot Surg, 2022, 16(6): 1307-1312.
[30]
Gamagami R, Dickens E, Gonzalez A, et al. Open versus robotic-assisted transabdominal preperitoneal(R-TAPP) inguinal hernia repair: a multicenter matched analysis of clinical outcomes[J].Hernia, 2018, 22(5): 827-836.
[31]
Gerdes S, Burger R, Liesch G, et al. Results of robotic TAPP and conventional laparoscopic TAPP in an outpatient setting: a cohort study in Switzerland[J]. Langenbecks Arch Surg, 2022, 407(6): 2563-2567.
[32]
Glasgow RE, Mulvihill SJ, Pettit JC, et al. Value Analysis of Methods of Inguinal Hernia Repair[J]. Ann Surg, 2021, 274(4): 572-580.
[33]
Gundogdu E, Guldogan CE, Ozmen MM. Bilateral Inguinal Hernia Repair: Robotic TAPP Versus Laparoscopic TEP[J]. Surg Laparosc Endosc Percutan Tech, 2020, 31(4): 439-443.
[34]
Holleran TJ, Napolitano MA, Sparks AD, et al. Trends and outcomes of open, laparoscopic, and robotic inguinal hernia repair in the veterans affairs system[J]. Hernia, 2022, 26(3): 889-899.
[35]
Hsu JL, Kelley JK, Zambito GM, et al. Comparison of Robotic,Laparoscopic, and Open Unilateral Repair of Non-recurrent Inguinal Hernia[J]. Am Surg, 2023, 89(11): 4793-4800.
[36]
Huerta S, Timmerman C, Argo M, et al. Open, Laparoscopic, and Robotic Inguinal Hernia Repair: Outcomes and Predictors of Complications[J]. J Surg Res, 2019, 241: 119-127.
[37]
Kakiashvili E, Bez M, Abu Shakra I, et al. Robotic inguinal hernia repair: Is it a new era in the management of inguinal hernia?[J].Asian J Surg, 2021, 44(1): 93-98.
[38]
Khoraki J, Gomez PP, Mazzini GS, et al. Perioperative outcomes and cost of robotic-assisted versus laparoscopic inguinal hernia repair[J].Surg Endosc, 2020, 34(8): 3496-3507.
[39]
Kolachalam R, Dickens E, D'amico L, et al. Early outcomes of robotic-assisted inguinal hernia repair in obese patients: a multiinstitutional, retrospective study[J]. Surg Endosc, 2018, 32(1): 229-235.
[40]
Kosturakis AK, Larusso KE, Carroll ND, et al. First 100 consecutive robotic inguinal hernia repairs at a Veterans Affairs hospital[J]. J Robot Surg, 2018, 12(4): 699-704.
[41]
Kudsi OY, Bou-Ayash N, Kaoukabani G, et al. Comparison of perioperative and mid-term outcomes between laparoscopic and robotic inguinal hernia repair[J]. Surg Endosc, 2023, 37(2): 1508-1514.
[42]
Kudsi OY, Mccarty JC, Paluvoi N, et al. Transition from Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair to Robotic Transabdominal Preperitoneal Inguinal Hernia Repair: A Retrospective Review of a Single Surgeon's Experience[J]. World J Surg, 2017, 41(9): 2251-2257.
[43]
Leblanc K, Dickens E, Gonzalez A, et al. Prospective, multicenter,pairwise analysis of robotic-assisted inguinal hernia repair with open and laparoscopic inguinal hernia repair: early results from the Prospective Hernia Study[J]. Hernia, 2020, 24(5): 1069-1081.
[44]
Muysoms F, Van Cleven S, Kyle-Leinhase I, et al. Robotic-assisted laparoscopic groin hernia repair: observational case-control study on the operative time during the learning curve[J]. Surg Endosc, 2018,32(12): 4850-4859.
[45]
Muysoms F, Vierstraete M, Nachtergaele F, et al. Economic assessment of starting robot-assisted laparoscopic inguinal hernia repair in a single-centre retrospective comparative study: the EASTER study[J]. BJS Open, 2021, 5(1): zraa046.
[46]
Okamoto N, Mineta S, Mishima K, et al. Comparison of short-term outcomes of robotic and laparoscopic transabdominal peritoneal repair for unilateral inguinal hernia: a propensity-score matched analysis[J]. Hernia, 2023, 27(5): 1131-1138.
[47]
Peltrini R, Corcione F, Pacella D, et al. Robotic versus laparoscopic transabdominal preperitoneal(TAPP) approaches to bilateral hernia repair: a multicenter retrospective study using propensity score matching analysis[J]. Surg Endosc, 2023, 37(2): 1188-1193.
[48]
Pokala B, Armijo PR, Flores L, et al. Minimally invasive inguinal hernia repair is superior to open: a national database review[J].Hernia, 2019, 23(3): 593-599.
[49]
Prabhu AS, Carbonell A, Hope W, et al. Robotic Inguinal vs Transabdominal Laparoscopic Inguinal Hernia Repair: The RIVAL Randomized Clinical Trial[J]. JAMA Surg, 2020, 155(5): 380-387.
[50]
Tonelli CM, Lorenzo I, Bunn C, et al. Contemporary Matched-Cohort Comparison of Surgical Approach to Inguinal Hernia Repair: Are Minimally Invasive Approaches Associated with Higher Rates of Recurrence?[J]. J Am Coll Surg, 2022, 235(1): 119-127.
[51]
Waite KE, Herman MA, Doyle PJ. Comparison of robotic versus laparoscopic transabdominal preperitoneal(TAPP) inguinal hernia repair[J]. J Robot Surg, 2016, 10(3): 239-244.
[52]
Merola G, Cavallaro G, Iorio O, et al. Learning curve in open inguinal hernia repair: a quality improvement multicentre study about Lichtenstein technique[J]. Hernia, 2020, 24(3): 651-659.
[53]
Haladu N, Alabi A, Brazzelli M, et al. Open versus laparoscopic repair of inguinal hernia: an overview of systematic reviews of randomised controlled trials[J]. Surg Endosc, 2022, 36(7): 4685-4700.
[54]
Pang NQ, Ng CSY, Wong CJH. Laparoscopic versus open groin hernia repair in older adults: a systematic review and meta-analysis[J]. ANZ J Surg, 2022, 92(10): 2457-2463.
[55]
Alip SL, Kim J, Rha KH, et al. Future Platforms of Robotic Surgery[J]. Urol Clin North Am, 2022, 49(1): 23-38.
[56]
Celotto F, Ramacciotti N, Mangano A, et al. Da Vinci single-port robotic system current application and future perspective in general surgery: A scoping review[J]. Surg Endosc, 2024, 38(9): 4814-4830.
[57]
Warren JA, Love M. Incisional Hernia Repair: Minimally Invasive Approaches[J]. Surg Clin North Am, 2018, 98(3): 537-559.
[58]
Aghayeva A, Aytac E, Dinc T, et al. Learning curve analysis of robotic transabdominal preperitoneal inguinal hernia repair[J]. Int J Med Robot, 2020, 16(6): 1-5.
[59]
Economopoulos KP, Mylonas KS, Stamou AA, et al. Laparoscopic versus robotic adrenalectomy: A comprehensive meta-analysis[J]. Int J Surg, 2017, 38: 95-104.
[60]
Bulyk I, Shkarban V, Vasyliuk S, et al. The history of inguinal hernia surgery[J]. Rozhl Chir, 2023, 102(4): 149-153.
[61]
Renshaw SM, Gupta A, Poulose BK. Establishing the minimal clinically important difference for the Hernia-Related Quality of Life Survey(HerQLes)[J]. Am J Surg, 2022, 223(2): 245-249.
[62]
Smith OA, Mierzwinski MF, Chitsabesan P, et al. Health-related quality of life in abdominal wall hernia: let's ask patients what matters to them?[J]. Hernia, 2022, 26(3): 795-808.
[63]
许文娟, 伍翠云, 许燕, 等. 标准化人文关怀服务在腹腔镜腹股沟疝修补术中的应用[J/OL]. 中华疝和腹壁外科杂志(电子版),2024, 18(4): 456-460.
[64]
Liu Q, Wang D, Sun Z, et al. Robot-assisted laparoscopic repair in hiatal hernia with kyphosis: A case report with meta-analysis[J]. Int J Abdom Wall Her, 2023, 6(2): 92-99.
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