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Maes-Carballo M, García-García M, Rodríguez-Janeiro I, Cámara-Martínez C, Alberca-Remigio C, Khan KS. A systematic review of robotic breast surgery versus open surgery. J Robot Surg 2023; 17:2583-2596. [PMID: 37624486 DOI: 10.1007/s11701-023-01698-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
Robotic-assisted breast surgery (RABS) is controversial. We systematically reviewed the evidence about RABS, comparing it to open conventional breast surgery (CBS). Following prospective registration (osf.io/97ewt), a search was performed in January 2023, without time or language restrictions, through bibliographic databases (PubMed, Web of Science, EMBASE, Scopus, Trip database and CDSR) and grey literature. Quality was assessed in duplicate using Qualsyst criteria (score range 0.0-1.0); reviewer agreement was 98%. The 16 selected studies (total patients: 334,804) had overall high quality (mean score 0.82; range 0.68-0.91). Nine of 16 (56.3%) were cohort studies, 2/16 (12.5%) RCTs, and 5/16 (31.3%) case-control studies. Taking p < 0.05 as the significance threshold, RABS versus CBS was better in aesthetic results and patient satisfaction (10/11 studies; 90%), was surgically costly (4/4 studies; 100%), time-consuming (9/13 studies; 69%), and less painful in the first 6-24 h (2/2 studies; 100%) and without statistically significant differences in complication rates (10/12 studies; 83%) or short-term oncological outcomes (10/10 studies; 100%). Surgical time could be dramatically reduced by training surgical teams, reaching no significant differences between approaches (p = 0.120). RABS was shown to be feasible and safe. The advantages of RABS and long-term outcomes need further research.
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Affiliation(s)
- Marta Maes-Carballo
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Calle Ramon Puga Noguerol, 54, 32005, Ourense, Spain.
- Hospital Público de Verín, Ourense, Spain.
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.
- Department of General Surgery, University of Santiago de Compostela, Santiago de Compostela, Spain.
| | - Manuel García-García
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Calle Ramon Puga Noguerol, 54, 32005, Ourense, Spain
- Department of General Surgery, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Iago Rodríguez-Janeiro
- Department of General Surgery, University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Claudia Alberca-Remigio
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Calle Ramon Puga Noguerol, 54, 32005, Ourense, Spain
| | - Khalid Saeed Khan
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Teo NZ, Ngu JCY. Robotic surgery in elderly patients with colorectal cancer: Review of the current literature. World J Gastrointest Surg 2023; 15:1040-1047. [PMID: 37405084 PMCID: PMC10315118 DOI: 10.4240/wjgs.v15.i6.1040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/04/2023] [Accepted: 04/19/2023] [Indexed: 06/15/2023] Open
Abstract
With an ageing global population, we will see an increasing number of elderly patients with colorectal cancer (CRC) requiring surgery. However, it should be recognized that the elderly are a heterogenous group, with varying physiological and functional status. While traditionally viewed to be associated with frailty, comorbidities, and a higher risk of post operative morbidity, the advancements in minimally invasive surgery (MIS) and improvements in perioperative care have allowed CRC surgery to be safe and feasible in the elderly - chronological age alone should therefore not strictly be an exclusion criterion for curative surgery. However, as a form of MIS, laparoscopic assisted colorectal surgery (LACS) has the inherent disadvantages of: (1) Dependence on a trained assistant for retraction and laparoscope control; (2) The loss of wristed movement with reduced dexterity and suboptimal ergonomics; (3) A lack of intuitive movement due to the levering effect of trocars; and (4) An amplification of physiological tremors. Representing a technical evolution of LACS, robotic assisted colorectal surgery was introduced to overcome these limitations. In this minireview, we examine the evidence for robotic surgery in the elderly with CRC.
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Affiliation(s)
- Nan Zun Teo
- Department of General Surgery, Changi General Hospital, Singapore 529889, Singapore
| | - James Chi Yong Ngu
- Department of General Surgery, Changi General Hospital, Singapore 529889, Singapore
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Jung WB. Current status of robotic surgery for colorectal cancer: A review. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2022. [DOI: 10.18528/ijgii220009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Won Beom Jung
- Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Korea
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