Robotic Versus Laparoscopic Colorectal Surgery

Background: Robotic approaches have become increas-ingly used for colorectal surgery. The aim of this study is to examine the safety and efficacy of robotic colorectal procedures in an adult population. Study Design: A systematic review of articles in both PubMed and Embase comparing laparoscopic and robotic colorectal procedures was performed. Clinical trials and observational studies in an adult population were in-cluded. Approaches were evaluated in terms of operative time, length of stay, estimated blood loss, number of lymph nodes harvested, and perioperative complications. Mean net differences and odds ratios were calculated to examine treatment effect of each group. Results: Two hundred eighteen articles were identified, and 17 met the inclusion criteria, representing 4,342 pa-tients: 920 robotic and 3,422 in the laparoscopic group. Operative time for the robotic approach was 38.849 min-utes longer (95 % confidence interval: 17.944 to 59.755). The robotic group had lower estimated blood loss (14.17 mL; 95 % confidence interval: –27.63 to –1.60), and pa-tients were 1.78 times more likely to be converted to an open procedure (95 % confidence interval: 1.24 to 2.55). There was no difference between groups with respect to number of lymph nodes harvested, length of stay, read-mission rate, or perioperative complication rate. Conclusions: The robotic approach to colorectal surgery is as safe and efficacious as conventional laparoscopic surgery. However, it is associated with longer operative time and an increased rate of conversion to laparotomy. Further prospective randomized controlled trials are war-ranted to examine the cost-effectiveness of robotic colo-rectal surgery before it can be adopted as the new stan-dard of care