A comparison between robotic, laparoscopic and open hepatectomy: A systematic review and network meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and network meta-analysis of comparative studies
PubMed 32312592 · doi:10.1016/j.ejso.2020.03.227
What was done
A systematic review and network meta-analysis was conducted across PubMed, Google Scholar, EMBASE, and the Cochrane Library comparing robotic hepatectomy (RH), laparoscopic hepatectomy (LH), and open hepatectomy (OH). Cost-effectiveness and survival benefits were designated as primary outcomes.
What was found
The abstract reports no numerical values, effect sizes, or confidence intervals. Cost differences between RH, LH, and OH were not statistically significant, though OH had lower costs than both minimally invasive approaches and LH had lower costs than RH. Both RH and LH were associated with significantly lower estimated blood loss, lower major morbidity, and shorter hospital stays compared to OH. Operative time and duration of clamping were significantly shorter for LH and OH compared to RH. Tumors were significantly smaller in the LH cohort than in the OH cohort.
Why it matters
This network meta-analysis suggests that both robotic and laparoscopic hepatectomy provide perioperative recovery benefits over open resection without statistically significant increases in total procedure costs, despite longer operative times for robotic surgery.
Limits
The abstract lacks all numerical data, effect sizes, and study counts (n is not reported). Baseline confounding is evident from baseline tumor size differences between groups, and it is unclear from the abstract whether included studies were randomized trials or observational cohorts.
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