Jan 23, 2018
Robot-assisted laparoscopic surgery versus conventional laparoscopic surgery in randomized controlled trials: a systematic review and meta-analysis
- Hyunsuk Frank Roh1,
- Seung Hyuk Nam2,
- Jung Mogg Kim3
- 1Department of Biomedical Science, Hanyang University College of Medicine and Graduate School of Biomedical Science and Engineering, Seoul, Korea.;
- 2Department of Thoracic and Cardiovascular Surgery, Hanyang University Guri Hospital, Guri, Gyunggi, Korea.;
- 3Department of Microbiology and Biomedical Science, Hanyang University College of Medicine and Graduate School of Biomedical Science and Engineering, Seoul, Korea.
External link: https://doi.org/10.1371/journal.pone.0191628
Protocol Citation: Hyunsuk Frank Roh, Seung Hyuk Nam, Jung Mogg Kim 2018. Robot-assisted laparoscopic surgery versus conventional laparoscopic surgery in randomized controlled trials: a systematic review and meta-analysis. protocols.io https://dx.doi.org/10.17504/protocols.io.k7ucznw
Manuscript citation:
Roh HF, Nam SH, Kim JM (2018) Robot-assisted laparoscopic surgery versus conventional laparoscopic surgery in randomized controlled trials: A systematic review and meta-analysis. PLoS ONE 13(1): e0191628. doi: 10.1371/journal.pone.0191628
License: This is an open access protocol distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Protocol status: Working
We use this protocol and it's working
Created: December 10, 2017
Last Modified: March 23, 2018
Protocol Integer ID: 9172
Keywords: Robot-assisted laparoscopic surgery, Meta-analysis, efficacy of surgical robotics, laparoscopic surgery versus conventional laparoscopic surgery, assisted laparoscopic surgery, laparoscopic surgery, conventional laparoscopic surgery, surgical robotics, comprehensive comparison of treatment outcome, controversial fields on surgical procedure, controlled trial, full subgroup analyses on each surgical procedure, individual surgical procedure, higher operative cost, systematic review, robot, treatment outcome, better treatment outcome, significant advantages in total operative time, surgical procedure, patients per report, conversion rate on colectomy, operative cost, clinical report, hysterectomy, colectomy, efficacy, surgery, outcome, evidence review
Abstract
IMPORTANCE: This review provides a comprehensive comparison of treatment outcomes between robot-assisted laparoscopic surgery (RLS) and conventional laparoscopic surgery (CLS) based on randomly-controlled trials (RCTs).
OBJECTIVES: We employed RCTs to provide a systematic review that will enable the relevant community to weigh the effectiveness and efficacy of surgical robotics in controversial fields on surgical procedures both overall and on each individual surgical procedure.
EVIDENCE REVIEW: A search was conducted for RCTs in PubMed, EMBASE, and Cochrane databases from 1981 to 2016. Among a total of 1,517 articles, 27 clinical reports with a mean sample size of 65 patients per report (32.7 patients who underwent RLS and 32.5 who underwent CLS), met the inclusion criteria.
FINDINGS: CLS shows significant advantages in total operative time, net operative time, total complication rate, and operative cost (p < 0.05 in all cases), whereas the estimated blood loss was less in RLS (p < 0.05). As subgroup analyses, conversion rate on colectomy and length of hospital stay on hysterectomy statistically favors RLS (p < 0.05).
CONCLUSIONS: Despite higher operative cost, RLS does not result in statistically better treatment outcomes, with the exception of lower estimated blood loss. Operative time and total complication rate are significantly more favorable with CLS. More RCT evidence is needed to be accumulated in order to enable full subgroup analyses on each surgical procedure.
Troubleshooting
Performing a pilot study (PilotStudy.xlsx)
It is necessary to perform pilot studies using the previous meta-analysis. In our previous pilot study, we found how difficult it is to combine these large-scale datasets. Initially, we designed to integrate all the RCT, prospective, and retrospective studies. To ensure correctness during our information gathering process, we had a well-organized dataset with highlighted errors suspected to have occurred in earlier meta-analyses. This approach proved to be beneficial, since we could benchmark meta-analyses of each surgical domain and cross-check our analysis results against the published analyses of previous meta-analyses. Although we later chose to narrow our scope only to RCT, the previous meta-analyses were excerpted in this study, hoping that this may save other researchers’ time and efforts when approaching this topic. In addition, although the first two authors independently performed the search, it is essential to share the protocol before the actual data gathering procedure, based on the pilot study.
[Identification] Actual search keywords employed
(1) Pubmed
((((robot[Title/Abstract] OR robotic[Title/Abstract] OR robotics[Title/Abstract] OR robotically[Title/Abstract] OR robot-assisted[Title/Abstract] OR robotic-assisted[Title/Abstract])) AND (laparoscopic[Title/Abstract] OR laparoscopy[Title/Abstract] OR laparoscope[Title/Abstract])) AND (randomized[Title/Abstract] OR randomised[Title/Abstract] OR random[Title/Abstract] OR RCT[Title/Abstract])) AND ('1981/01/01'[Date - Publication] : '2016/12/31'[Date - Publication])
(2) EMBASE
robot:ab,ti OR robotic:ab,ti OR robotics:ab,ti OR robotically:ab,ti OR 'robot assisted':ab,ti OR 'robotic assisted':ab,ti AND (laparoscopic:ab,ti OR laparoscopy:ab,ti OR laparoscope:ab,ti) AND (randomized:ab,ti OR randomised:ab,ti OR random:ab,ti OR rct:ab,ti) AND [1981-2016]/py
(3) Cochrane
[Title,Abstract,Keywords] robot or robotic or robotics or robotically or robot-assisted or robotic-assisted AND [Title,Abstract,Keywords] laparoscopic or laparoscopy or laparoscope AND [Title,Abstract,Keywords] randomized OR randomised OR random OR RCT
Publication Year from 1981 to 2016:
[Screening, Eligibility, and Inclusion] Using the uploaded Worksheet.xlsx
(1) The study used the uploaded worksheet to indicate the duplicates identified by the Python script (CountingDuplicates.py) or later manually to double-check. All the studies in Cochrane were also found in PubMed or EMBASE. (Please change its extension from pdf to py: CountingDuplicates.pdf => CountingDuplicates.py)
(2) The first two authors screened the PubMed data based on the name and abstract. Whenever a suspicion arose, full-texts were examined. In the worksheet, the first two authors indicated whether the full-text was available, whether the study was RCT; the language, relevance, and other comments were also specified.
Similarly, the first two authors screened the EMBASE data based on the name and abstract. In the case of doubt, full-texts were examined using Web of Science (Core) and SCOPUS to find the full text. In the worksheet, what database had the full text was indicated in order for the other author to later double-check whether, in fact, the full text could be found.
The senior author later decided whether to include/exclude the study for any discrepancies between the first two authors. As indicated by the worksheet, we double-checked the worksheet as well.