Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Oct 28, 2021; 9(5): 462-473
Published online Oct 28, 2021. doi: 10.13105/wjma.v9.i5.462
Maturation of robotic liver resection during the last decade: A systematic review and meta-analysis
Tomohiro Ishinuki, Shigenori Ota, Kohei Harada, Makoto Meguro, Masaki Kawamoto, Goro Kutomi, Hiroomi Tatsumi, Keisuke Harada, Koji Miyanishi, Ichiro Takemasa, Toshio Ohyanagi, Thomas T Hui, Toru Mizuguchi
Tomohiro Ishinuki, Toru Mizuguchi, Department of Nursing, Surgical Sciences, Sapporo Medical University, Sapporo 0608556, Hokkaido, Japan
Shigenori Ota, Ichiro Takemasa, Departments of Surgery, Surgical Science and Oncology, Sapporo Medical University, Sapporo 0608543, Hokkaido, Japan
Kohei Harada, Division of Radiology, Sapporo Medical University, Sapporo 060-8543, Hokkaido, Japan
Makoto Meguro, Departments of Surgery, Sapporo Satozuka Hospital, Sapporo 0048686, Japan
Masaki Kawamoto, Departments of Surgery, Nemuro City Hospital, Nemuro 0878686, Hokkaido, Japan
Goro Kutomi, Department of Surgery, School of Medicine, Sapporo Medical University, Sapporo 0608543, Hokkaido, Japan
Hiroomi Tatsumi, Department of Intensive Care Medicine, Sapporo Medical University Hospital, Sapporo 0608543, Hokkaido, Japan
Keisuke Harada, Department of Emergency Medicine, Sapporo Medical University, Sapporo 0606543, Hokkaido, Japan
Koji Miyanishi, Department of Medical Oncology, Sapporo Medical University, Sapporo 0608543, Hokkaido, Japan
Toshio Ohyanagi, Department of Liberal Arts and Sciences, Center for Medical Education, Sapporo Medical University, Sapporo 0608556, Hokkaido, Japan
Thomas T Hui, Department of Surgery, Division of Pediatric Surgery, Stanford University School of Medicine, Stanford, CA 94598, United States
Author contributions: Ishinuki T and Ota S developed the study concept and designed the systematic review; Ishinuki T, Meguro M, and Ohyanagi T searched for and screened the articles; Kawamoto M, Harada K, and Tatsumi H assessed the articles for eligibility; Miyanishi K carried out the statistical analyses; Takemasa I supervised and audited the preparation of the manuscript; Hui TT and Mizuguchi T drafted the initial manuscript; Mizuguchi T finalized the manuscript; All of the authors reviewed and approved the final submitted manuscript.
Supported by Grants-in-Aid from JSPS KAKENHI, No. JP 20K10404 (to Mizuguchi T); the Hokkaido Hepatitis B Litigation Orange Fund, No. 2059198; Terumo Life Science Foundation, No. 2000666; Pfizer Health Research Foundation, No. 2000777; the Viral Hepatitis Research Foundation of Japan, No. 2000638; Daiichi Sankyo Company, No. 2109540; Shionogi and Co., No. 2109493; MSD, No. 2099412; Takeda, No. 2000555; Sapporo Doto Hospital, No. 2039118; Noguchi Hospital, No. 2029083; Doki-kai Tomakomai Hospital, No. 2059203; and Tsuchida Hospital, No. 2069231.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist statement, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Toru Mizuguchi, MD, PhD, Professor, Department of Nursing, Surgical Sciences, Sapporo Medical University, S1, W17, Chuo-ku, Sapporo 0608556, Hokkaido, Japan. tmizu@sapmed.ac.jp
Received: April 13, 2021
Peer-review started: April 13, 2021
First decision: June 24, 2021
Revised: July 1, 2021
Accepted: August 23, 2021
Article in press: August 23, 2021
Published online: October 28, 2021
Processing time: 198 Days and 6.5 Hours
Abstract
BACKGROUND

Minimally invasive hepatectomy techniques have developed rapidly since 2000. Pure laparoscopic liver resection (LLR) has become the primary approach for managing liver tumors and procuring donor organs for liver transplantation. Robotic liver resection (RLR) has emerged during the last decade. The technical status of RLR seems to be improving.

AIM

To conduct a systematic review and meta-analysis comparing the short-term clinical outcomes of LLR and RLR over two 5-year periods.

METHODS

A systematic literature search was performed using PubMed and Medline, including the Cochrane Library. The following inclusion criteria were set for the meta-analysis: (1) Studies comparing LLR vs RLR; and (2) Studies that described clinical outcomes, such as the operative time, intraoperative bleeding, intraoperative conversion rate, and postoperative complications.

RESULTS

A total of 25 articles were included in this meta-analysis after 40 articles had been subjected to full-text evaluations. The studies were divided into early (n = 14) and recent (n = 11) groups. In the recent group, the operative time did not differ significantly between LLR and RLR (P = 0.70), whereas in the early group the operative time of LLR was significantly shorter than that of RLR (P < 0.001).

CONCLUSION

The initial disadvantages of RLR, such as its long operation time, have been overcome during the last 5 years. The other clinical outcomes of RLR are comparable to those of LLR. The cost and quality-of-life outcomes of RLR should be evaluated in future studies to promote its routine clinical use.

Keywords: Hepatectomy; Laparoscopy; Robot; Operation time

Core Tip: A systematic review and meta-analysis comparing the clinical outcomes of laparoscopic liver resection (LLR) and robotic liver resection (RLR) was conducted. A total of 25 studies were included in the meta-analysis. In the recent studies, operative time did not differ significantly between LLR and RLR (P = 0.70), whereas in the early studies LLR was associated with significantly shorter operative times than RLR (P < 0.001). The initial disadvantages of RLR have been overcome during the last 5 years.