Clinical outcomes of Da-Vinci robot-assisted versus video-assisted thoracoscopic surgery for mediastinal tumors:A systematic review and meta-analysis
Objective To systematically evaluate of the difference in clinical outcomes between Da-Vinci robot-assisted thoracoscopic surgery(RATS)and video-assisted thoracoscopic surgery(VATS)for mediastinal tumor resection.Methods Online databases including The Cochrane Library,PubMed,EMbase,Web of Science,SinoMed,CNKI,and Wanfang were searched by two researchers independently from inception to October 10,2022.The quality of the included literature was evaluated using the Newcastle-Ottawa Scale(NOS).The meta-analysis was performed by RevMan 5.3.Results A total of 23 studies with 5 646 patients were enrolled in the final study.The NOS scores of the studies were ≥6 points.The results of meta-analysis showed that compared with the VATS group,the blood loss was less[MD=-18.11,95％CI(-26.12,-10.09),P＜0.001],time of postoperative drainage tube retention[MD=-0.79,95％CI(-1.09,-0.49),P＜0.001]and postoperative hospitalization time[MD=-1.00,95％CI(-1.36,-0.64),P＜0.001]were shorter,postoperative day 1 drainage[MD=-5.53,95％CI(-9.94,-1.12),P=0.010]and total postoperative drainage[MD=-88.41,95％CI(-140.85,-35.97),P=0.001]were less,the rates of postoperative complications[OR=0.66,95％CI(0.46,0.94),P=0.020]and conversion to thoracotomy[OR=0.32,95％CI(0.19,0.53),P＜0.001]were lower,and the hospitalization costs were higher[MD=2.60,95％CI(1.40,3.79),P＜0.001]in the RATS group.The operative time was not statistically different between the two groups[MD=5.94,95％CI(-1.45,13.34),P=0.120].Conclusion RATS mediastinal tumor resection has a high safety profile.Compared with VATS,patients have less intraoperative blood loss,a lower rate of conversion to thoracotomy,and shorter postoperative tube time and hospital stay,which is more conducive to rapid postoperative recovery.
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