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Shenoy R, Mederos MA, Ye L, Mak SS, Begashaw MM, Booth MS, Shekelle PG, Wilson M, Gunnar W, Maggard-Gibbons M, Girgis MD. Intraoperative and postoperative outcomes of robot-assisted cholecystectomy: a systematic review. Syst Rev 2021; 10:124. [PMID: 33892794 PMCID: PMC8067374 DOI: 10.1186/s13643-021-01673-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/09/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Rapid adoption of robotic-assisted general surgery procedures, particularly for cholecystectomy, continues while questions remain about its benefits and utility. The objective of this study was to compare the clinical effectiveness of robot-assisted cholecystectomy for benign gallbladder disease as compared with the laparoscopic approach. METHODS A literature search was performed from January 2010 to March 2020, and a narrative analysis was performed as studies were heterogeneous. RESULTS Of 887 articles screened, 44 met the inclusion criteria (range 20-735,537 patients). Four were randomized controlled trials, and four used propensity-matching. There were variable comparisons between operative techniques with only 19 out of 44 studies comparing techniques using the same number of ports. Operating room time was longer for the robot-assisted technique in the majority of studies (range 11-55 min for 22 studies, p < 0.05; 15 studies showed no difference; two studies showed shorter laparoscopic times), while conversion rates and intraoperative complications were not different. No differences were detected for the length of stay, surgical site infection, or readmissions. Across studies comparing single-port robot-assisted to multi-port laparoscopic cholecystectomy, there was a higher rate of incisional hernia; however, no differences were noted when comparing single-port robot-assisted to single-port laparoscopic cholecystectomy. CONCLUSIONS Clinical outcomes were similar for benign, elective gallbladder disease for robot-assisted compared with laparoscopic cholecystectomy. Overall, the rates of complications were low. More high-quality studies are needed as the robot-assisted technique expands to more complex gallbladder disease, where its utility may prove increasingly beneficial. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020156945.
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Affiliation(s)
- Rivfka Shenoy
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
- Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
- National Clinician Scholars Program, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Michael A Mederos
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Linda Ye
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Selene S Mak
- Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Meron M Begashaw
- Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | | | - Paul G Shekelle
- Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- RAND Corporation, Santa Monica, CA, USA
| | - Mark Wilson
- U.S. Department of Veterans Affairs, Washington D.C., USA
- Department of Surgery, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - William Gunnar
- National Center for Patient Safety, Veterans Health Administration, Ann Arbor, MI, USA
- University of Michigan, Ann Arbor, MI, USA
| | - Melinda Maggard-Gibbons
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- RAND Corporation, Santa Monica, CA, USA
- Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - Mark D Girgis
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Obesity and Pancreatic Cancer: A Matched-Pair Survival Analysis. J Clin Med 2020; 9:jcm9113526. [PMID: 33142763 PMCID: PMC7693315 DOI: 10.3390/jcm9113526] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/20/2020] [Accepted: 10/28/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Morbid obesity is a risk factor for pancreatic ductal adenocarcinoma (PDAC). However, the impact of obesity on postoperative outcomes and overall survival in patients with PDAC remains a controversial topic. METHODS Patients who underwent pancreatic surgery for PDAC between 1997 and 2018 were included in this study. Matched pairs (1:1) were generated according to age, gender and American Society of Anesthesiologists status. Obesity was defined according to the WHO definition as BMI ≥ 30 kg/m2. The primary endpoint was the difference in overall survival between patients with and without obesity. RESULTS Out of 553 patients, a total of 76 fully matched pairs were generated. Obese patients had a mean BMI-level of 33 compared to 25 kg/m2 in patients without obesity (p = 0.001). The frequency of arterial hypertension (p = 0.002), intraoperative blood loss (p = 0.039), and perineural invasion (p = 0.033) were also higher in obese patients. Clinically relevant postoperative complications (p = 0.163) and overall survival rates (p = 0.885) were comparable in both study groups. Grade II and III obesity resulted in an impaired overall survival, although this was not statistically significant. Subgroup survival analyses revealed no significant differences for completion of adjuvant chemotherapy and curative-intent surgery. CONCLUSIONS Obesity did not affect overall survival and postoperative complications in these patients with PDAC. Therefore, pancreatic surgery should not be withheld from obese patients.
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