Short-term Outcomes Of Robotic-assisted Right Colectomy Compared With Laparoscopic Surgery: A Visualization-based Systematic Review And Meta-analysis

Objective: We analysed the literature on robotic surgery published in several databases using visualization software.The results revealed that there are few studies on robotic right hemicolectomy.Based on those results,we performed a systematic review and Meta-analysis of the published studies to assess the clinical efficacy and safety of robotic-assisted right colectomy(RRC)compared to conventional laparoscopic right colectomy(LRC).Methods: Following a pre-search,we used the Bibliographic Item Co-Occurrence Mining System(BICOMS)to analyse all the literature containing information related to robotic colorectal surgery.After analysing the visualization results,we decided to search certain databases,including the Cochrane Library of Clinical Comparative Trials,MEDLINE,Embase,Web of Science,Chinese Biomedical Literature Database(CBM)and the da Vinci surgery system database(www.davincisurgerydatabase.com)from 1973 to 2017 for comparative studies reporting preoperative outcomes for RRC and LRC.The censor date was January 2017.Operation time,estimated blood loss,length of hospital stay,rates of conversion to open surgery,postoperative complications,and related outcomes were evaluated.Stata 12.0 software was used for all calculations and statistical testing.Results: A total of 7769 patients with colon cancer were enrolled in 13 trials.All patients were divided into control group(n = 7095)and study group(n = 674).Meta-analysis suggested significantly greater length of hospital stay in the LRC group [MD =-0.85;95% CI:-1.07 to-0.63;P < 0.00001].Robotic surgery was also associated with a significantly lower complication rate [OR= 0.73;95% CI: 0.52 to 1.01;P = 0.05] and a significantly shorter time to recovery of bowel function [MD =-0.58,95% CI:-0.96 to-0.20,P = 0.0008].There were statistically significant differences between the groups in estimated blood loss [MD =-16.89;95% CI:-24.80 to –8.98;P < 0.00001] and the rate of intraoperative conversion to open surgery [OR = 0.34,95% CI: 0.15 to 0.75;P = 0.008)],but these differences were not clinically relevant.However,operation times [MD = 43.61,95% CI: 39.11 to 48.10,P < 0.00001] were longer for RRC than for LRC.Conclusion: Compared to LRC,RRC was associated with reduced estimated blood loss,reduced postoperative complications,longer operation times,and significantly faster recovery of bowel function.Other perioperative outcomes were equivalent between the two surgeries.Additionally,the guidance of literature visualization analysis can enhance the efficiency and clarity of choosing a research direction.