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

doi:10.3877/cma.j.issn.1674-392X.2024.05.023

Abstract

Abstract:

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

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.

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Figures/Tables 11

References 64

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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

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

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

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

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