Robotic versus laparoscopic right colectomy: a meta-analysis
Identifieur interne : 000894 ( Pmc/Curation ); précédent : 000893; suivant : 000895Robotic versus laparoscopic right colectomy: a meta-analysis
Auteurs : Huirong Xu [République populaire de Chine] ; Jianning Li [République populaire de Chine] ; Yanlai Sun [République populaire de Chine] ; Zengjun Li [République populaire de Chine] ; Yanan Zhen [République populaire de Chine] ; Bin Wang [République populaire de Chine] ; Zhongfa Xu [République populaire de Chine]Source :
- World Journal of Surgical Oncology [ 1477-7819 ] ; 2014.
Abstract
The objective of this meta-analysis was to compare the clinical safety and efficacy of robotic right colectomy (RRC) with conventional laparoscopic right colectomy (LRC).
A literature search was performed for comparative studies reporting perioperative outcomes of RRC and LRC. The methodological quality of the selected studies was assessed. Depending on statistical heterogeneity, the fixed effects model or the random effects model were used for the meta-analysis. Operative time, estimated blood loss, length of hospital stay, conversion rates to open surgery, postoperative complications, and related outcomes were evaluated.
Seven studies, including 234 RRC cases and 415 conventional LRC cases, were analyzed. The meta-analysis showed that RRC had longer operative times (
Compared to LRC, RRC was associated with reduced estimated blood losses, reduced postoperative complications, longer operative times, and a significantly faster recovery of bowel function. Other perioperative outcomes were equivalent.
Url:
DOI: 10.1186/1477-7819-12-274
PubMed: 25169141
PubMed Central: 4158068
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Robotic versus laparoscopic right colectomy: a meta-analysis</title><author><name sortKey="Xu, Huirong" sort="Xu, Huirong" uniqKey="Xu H" first="Huirong" last="Xu">Huirong Xu</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Colorectal Cancer Surgery, Shandong cancer hospital, 440 Jiyan Road, Jinan, 250117 China</nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Colorectal Cancer Surgery, Shandong cancer hospital, 440 Jiyan Road, Jinan</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff2">Shandong Academy of Medical Sciences, Jingshi Road, Jinan, 250062 China</nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Shandong Academy of Medical Sciences, Jingshi Road, Jinan</wicri:regionArea></affiliation></author><author><name sortKey="Li, Jianning" sort="Li, Jianning" uniqKey="Li J" first="Jianning" last="Li">Jianning Li</name><affiliation wicri:level="1"><nlm:aff id="Aff3">Department of Anesthesiology and Operation, Affiliated Hospital of Shandong Academy of Medical Sciences, 38 Wuyingshan Road, Jinan, 250031 China</nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Anesthesiology and Operation, Affiliated Hospital of Shandong Academy of Medical Sciences, 38 Wuyingshan Road, Jinan</wicri:regionArea></affiliation></author><author><name sortKey="Sun, Yanlai" sort="Sun, Yanlai" uniqKey="Sun Y" first="Yanlai" last="Sun">Yanlai Sun</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Colorectal Cancer Surgery, Shandong cancer hospital, 440 Jiyan Road, Jinan, 250117 China</nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Colorectal Cancer Surgery, Shandong cancer hospital, 440 Jiyan Road, Jinan</wicri:regionArea></affiliation></author><author><name sortKey="Li, Zengjun" sort="Li, Zengjun" uniqKey="Li Z" first="Zengjun" last="Li">Zengjun Li</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Colorectal Cancer Surgery, Shandong cancer hospital, 440 Jiyan Road, Jinan, 250117 China</nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Colorectal Cancer Surgery, Shandong cancer hospital, 440 Jiyan Road, Jinan</wicri:regionArea></affiliation></author><author><name sortKey="Zhen, Yanan" sort="Zhen, Yanan" uniqKey="Zhen Y" first="Yanan" last="Zhen">Yanan Zhen</name><affiliation wicri:level="1"><nlm:aff id="Aff4">Department of Gastrointestinal surgery, Affiliated Hospital of Shandong Academy of Medical Sciences, 38 Wuyingshan Road, Jinan, 250031 China</nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Gastrointestinal surgery, Affiliated Hospital of Shandong Academy of Medical Sciences, 38 Wuyingshan Road, Jinan</wicri:regionArea></affiliation></author><author><name sortKey="Wang, Bin" sort="Wang, Bin" uniqKey="Wang B" first="Bin" last="Wang">Bin Wang</name><affiliation wicri:level="1"><nlm:aff id="Aff4">Department of Gastrointestinal surgery, Affiliated Hospital of Shandong Academy of Medical Sciences, 38 Wuyingshan Road, Jinan, 250031 China</nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Gastrointestinal surgery, Affiliated Hospital of Shandong Academy of Medical Sciences, 38 Wuyingshan Road, Jinan</wicri:regionArea></affiliation></author><author><name sortKey="Xu, Zhongfa" sort="Xu, Zhongfa" uniqKey="Xu Z" first="Zhongfa" last="Xu">Zhongfa Xu</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Colorectal Cancer Surgery, Shandong cancer hospital, 440 Jiyan Road, Jinan, 250117 China</nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Colorectal Cancer Surgery, Shandong cancer hospital, 440 Jiyan Road, Jinan</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff4">Department of Gastrointestinal surgery, Affiliated Hospital of Shandong Academy of Medical Sciences, 38 Wuyingshan Road, Jinan, 250031 China</nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Gastrointestinal surgery, Affiliated Hospital of Shandong Academy of Medical Sciences, 38 Wuyingshan Road, Jinan</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25169141</idno><idno type="pmc">4158068</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4158068</idno><idno type="RBID">PMC:4158068</idno><idno type="doi">10.1186/1477-7819-12-274</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">000894</idno><idno type="wicri:Area/Pmc/Curation">000894</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Robotic versus laparoscopic right colectomy: a meta-analysis</title><author><name sortKey="Xu, Huirong" sort="Xu, Huirong" uniqKey="Xu H" first="Huirong" last="Xu">Huirong Xu</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Colorectal Cancer Surgery, Shandong cancer hospital, 440 Jiyan Road, Jinan, 250117 China</nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Colorectal Cancer Surgery, Shandong cancer hospital, 440 Jiyan Road, Jinan</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff2">Shandong Academy of Medical Sciences, Jingshi Road, Jinan, 250062 China</nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Shandong Academy of Medical Sciences, Jingshi Road, Jinan</wicri:regionArea></affiliation></author><author><name sortKey="Li, Jianning" sort="Li, Jianning" uniqKey="Li J" first="Jianning" last="Li">Jianning Li</name><affiliation wicri:level="1"><nlm:aff id="Aff3">Department of Anesthesiology and Operation, Affiliated Hospital of Shandong Academy of Medical Sciences, 38 Wuyingshan Road, Jinan, 250031 China</nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Anesthesiology and Operation, Affiliated Hospital of Shandong Academy of Medical Sciences, 38 Wuyingshan Road, Jinan</wicri:regionArea></affiliation></author><author><name sortKey="Sun, Yanlai" sort="Sun, Yanlai" uniqKey="Sun Y" first="Yanlai" last="Sun">Yanlai Sun</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Colorectal Cancer Surgery, Shandong cancer hospital, 440 Jiyan Road, Jinan, 250117 China</nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Colorectal Cancer Surgery, Shandong cancer hospital, 440 Jiyan Road, Jinan</wicri:regionArea></affiliation></author><author><name sortKey="Li, Zengjun" sort="Li, Zengjun" uniqKey="Li Z" first="Zengjun" last="Li">Zengjun Li</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Colorectal Cancer Surgery, Shandong cancer hospital, 440 Jiyan Road, Jinan, 250117 China</nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Colorectal Cancer Surgery, Shandong cancer hospital, 440 Jiyan Road, Jinan</wicri:regionArea></affiliation></author><author><name sortKey="Zhen, Yanan" sort="Zhen, Yanan" uniqKey="Zhen Y" first="Yanan" last="Zhen">Yanan Zhen</name><affiliation wicri:level="1"><nlm:aff id="Aff4">Department of Gastrointestinal surgery, Affiliated Hospital of Shandong Academy of Medical Sciences, 38 Wuyingshan Road, Jinan, 250031 China</nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Gastrointestinal surgery, Affiliated Hospital of Shandong Academy of Medical Sciences, 38 Wuyingshan Road, Jinan</wicri:regionArea></affiliation></author><author><name sortKey="Wang, Bin" sort="Wang, Bin" uniqKey="Wang B" first="Bin" last="Wang">Bin Wang</name><affiliation wicri:level="1"><nlm:aff id="Aff4">Department of Gastrointestinal surgery, Affiliated Hospital of Shandong Academy of Medical Sciences, 38 Wuyingshan Road, Jinan, 250031 China</nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Gastrointestinal surgery, Affiliated Hospital of Shandong Academy of Medical Sciences, 38 Wuyingshan Road, Jinan</wicri:regionArea></affiliation></author><author><name sortKey="Xu, Zhongfa" sort="Xu, Zhongfa" uniqKey="Xu Z" first="Zhongfa" last="Xu">Zhongfa Xu</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Colorectal Cancer Surgery, Shandong cancer hospital, 440 Jiyan Road, Jinan, 250117 China</nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Colorectal Cancer Surgery, Shandong cancer hospital, 440 Jiyan Road, Jinan</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff4">Department of Gastrointestinal surgery, Affiliated Hospital of Shandong Academy of Medical Sciences, 38 Wuyingshan Road, Jinan, 250031 China</nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Gastrointestinal surgery, Affiliated Hospital of Shandong Academy of Medical Sciences, 38 Wuyingshan Road, Jinan</wicri:regionArea></affiliation></author></analytic><series><title level="j">World Journal of Surgical Oncology</title><idno type="eISSN">1477-7819</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>The objective of this meta-analysis was to compare the clinical safety and efficacy of robotic right colectomy (RRC) with conventional laparoscopic right colectomy (LRC).</p></sec><sec><title>Methods</title><p>A literature search was performed for comparative studies reporting perioperative outcomes of RRC and LRC. The methodological quality of the selected studies was assessed. Depending on statistical heterogeneity, the fixed effects model or the random effects model were used for the meta-analysis. Operative time, estimated blood loss, length of hospital stay, conversion rates to open surgery, postoperative complications, and related outcomes were evaluated.</p></sec><sec><title>Results</title><p>Seven studies, including 234 RRC cases and 415 conventional LRC cases, were analyzed. The meta-analysis showed that RRC had longer operative times (<italic>P</italic> < 0.00001), lower estimated blood losses (<italic>P</italic> = 0.0002), lower postoperative overall complications (<italic>P</italic> = 0.02), and significantly faster bowel function recovery (<italic>P</italic> < 0.00001). There were no differences in the length of hospital stay (<italic>P</italic> = 0.12), conversion rates to open surgery (<italic>P</italic> = 0.48), postoperative ileus (<italic>P</italic> = 0.08), anastomosis leakage (<italic>P</italic> = 0.28), and bleeding (<italic>P</italic> = 0.95).</p></sec><sec><title>Conclusions</title><p>Compared to LRC, RRC was associated with reduced estimated blood losses, reduced postoperative complications, longer operative times, and a significantly faster recovery of bowel function. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">World J Surg Oncol</journal-id><journal-id journal-id-type="iso-abbrev">World J Surg Oncol</journal-id><journal-title-group><journal-title>World Journal of Surgical Oncology</journal-title></journal-title-group><issn pub-type="epub">1477-7819</issn><publisher><publisher-name>BioMed Central</publisher-name><publisher-loc>London</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25169141</article-id><article-id pub-id-type="pmc">4158068</article-id><article-id pub-id-type="publisher-id">1754</article-id><article-id pub-id-type="doi">10.1186/1477-7819-12-274</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research</subject></subj-group></article-categories><title-group><article-title>Robotic versus laparoscopic right colectomy: a meta-analysis</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Xu</surname><given-names>Huirong</given-names></name><address><email>xuhuirong676@163.com</email></address><xref ref-type="aff" rid="Aff1"></xref><xref ref-type="aff" rid="Aff2"></xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Li</surname><given-names>Jianning</given-names></name><address><email>l1979jn@126.com</email></address><xref ref-type="aff" rid="Aff3"></xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Sun</surname><given-names>Yanlai</given-names></name><address><email>sunyanlai@126.com</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Li</surname><given-names>Zengjun</given-names></name><address><email>Lizengjun676@163.com</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Zhen</surname><given-names>Yanan</given-names></name><address><email>Zhenyanan676@163.com</email></address><xref ref-type="aff" rid="Aff4"></xref></contrib><contrib contrib-type="author"><name><surname>Wang</surname><given-names>Bin</given-names></name><address><email>Wangbin797@163.com</email></address><xref ref-type="aff" rid="Aff4"></xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Xu</surname><given-names>Zhongfa</given-names></name><address><email>xzfa2216@163.com</email></address><xref ref-type="aff" rid="Aff1"></xref><xref ref-type="aff" rid="Aff4"></xref></contrib><aff id="Aff1"><label></label>Department of Colorectal Cancer Surgery, Shandong cancer hospital, 440 Jiyan Road, Jinan, 250117 China</aff><aff id="Aff2"><label></label>Shandong Academy of Medical Sciences, Jingshi Road, Jinan, 250062 China</aff><aff id="Aff3"><label></label>Department of Anesthesiology and Operation, Affiliated Hospital of Shandong Academy of Medical Sciences, 38 Wuyingshan Road, Jinan, 250031 China</aff><aff id="Aff4"><label></label>Department of Gastrointestinal surgery, Affiliated Hospital of Shandong Academy of Medical Sciences, 38 Wuyingshan Road, Jinan, 250031 China</aff></contrib-group><pub-date pub-type="epub"><day>28</day><month>8</month><year>2014</year></pub-date><pub-date pub-type="pmc-release"><day>28</day><month>8</month><year>2014</year></pub-date><pub-date pub-type="collection"><year>2014</year></pub-date><volume>12</volume><elocation-id>274</elocation-id><history><date date-type="received"><day>19</day><month>1</month><year>2014</year></date><date date-type="accepted"><day>16</day><month>8</month><year>2014</year></date></history><permissions><copyright-statement>© Xu et al.; licensee BioMed Central Ltd. 2014</copyright-statement><license license-type="open-access"><license-p>This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/2.0">http://creativecommons.org/licenses/by/2.0</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</ext-link>) applies to the data made available in this article, unless otherwise stated.</license-p></license></permissions><abstract id="Abs1"><sec><title>Background</title><p>The objective of this meta-analysis was to compare the clinical safety and efficacy of robotic right colectomy (RRC) with conventional laparoscopic right colectomy (LRC).</p></sec><sec><title>Methods</title><p>A literature search was performed for comparative studies reporting perioperative outcomes of RRC and LRC. The methodological quality of the selected studies was assessed. Depending on statistical heterogeneity, the fixed effects model or the random effects model were used for the meta-analysis. Operative time, estimated blood loss, length of hospital stay, conversion rates to open surgery, postoperative complications, and related outcomes were evaluated.</p></sec><sec><title>Results</title><p>Seven studies, including 234 RRC cases and 415 conventional LRC cases, were analyzed. The meta-analysis showed that RRC had longer operative times (<italic>P</italic> < 0.00001), lower estimated blood losses (<italic>P</italic> = 0.0002), lower postoperative overall complications (<italic>P</italic> = 0.02), and significantly faster bowel function recovery (<italic>P</italic> < 0.00001). There were no differences in the length of hospital stay (<italic>P</italic> = 0.12), conversion rates to open surgery (<italic>P</italic> = 0.48), postoperative ileus (<italic>P</italic> = 0.08), anastomosis leakage (<italic>P</italic> = 0.28), and bleeding (<italic>P</italic> = 0.95).</p></sec><sec><title>Conclusions</title><p>Compared to LRC, RRC was associated with reduced estimated blood losses, reduced postoperative complications, longer operative times, and a significantly faster recovery of bowel function. Other perioperative outcomes were equivalent.</p></sec></abstract><kwd-group xml:lang="en"><title>Keywords</title><kwd>Da Vinci surgical system</kwd><kwd>Laparoscopic surgery</kwd><kwd>Right colectomy</kwd><kwd>Meta-analysis</kwd></kwd-group><custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name><meta-value>© The Author(s) 2014</meta-value></custom-meta></custom-meta-group></article-meta></front><body><sec id="Sec1"><title>Background</title><p>The da Vinci robotic surgical system was a significant technological advancement in minimally invasive surgery. It has been proved to be safe and successful in colorectal surgical operations. Minimally invasive robotic surgery has many advantages, such as three-dimensional high-definition field of view, tremor filtration, augmented dexterity, capability of telesurgery, and so on. Since Weber <italic>et al</italic>. first reported the robotic colectomy surgery in 2002 [<xref ref-type="bibr" rid="CR1">1</xref>], more and more surgeons were willing to use this technology. Studies have revealed the feasibility and safety of both robotic right colectomy (RRC) [<xref ref-type="bibr" rid="CR2">2</xref>, <xref ref-type="bibr" rid="CR3">3</xref>] and laparoscopic right colectomy (LRC) [<xref ref-type="bibr" rid="CR4">4</xref>, <xref ref-type="bibr" rid="CR5">5</xref>]. There are several studies comparing the outcomes of RRC against standard LRC, but no meta-analyses have been conducted to compare and integrate the results of these studies. The objective of this meta-analysis was to compare the safety and efficacy of RRC versus conventional LRC.</p></sec><sec id="Sec2" sec-type="methods"><title>Methods</title><sec id="Sec3"><title>Information sources and search</title><p>A literature search of the Medline, EMBASE, and Ovid databases for studies that compare clinical outcomes of RRC against LRC was performed. The abstracts published at major international conferences were also manually searched. In addition, the references listed in the articles that were included were manually searched for additional studies. The last search was performed in November 2013. There were no language restrictions. ‘Robotic/robotic assisted’, ‘right colectomy’, and ‘robotic/robotic assisted vs laparoscopic right colectomy’ were employed as search terms, and both free text and Medical Subject Headings (MeSH) were used.</p></sec><sec id="Sec4"><title>Study selection and quality assessment</title><p>Full-text articles of relevant studies were obtained and independently assessed by two authors (XHR and SYL) to determine their criteria for inclusion. Disagreements on inclusion were solved through discussions and, if necessary, a third independent author (XZF) was involved. To evaluate the quality of the identified studies, the Jadad scale [<xref ref-type="bibr" rid="CR6">6</xref>] was used for assessing randomized studies, and ‘Methodological Items for Non-Randomized Studies’ [<xref ref-type="bibr" rid="CR7">7</xref>] was used to assess non-randomized studies.</p></sec><sec id="Sec5"><title>Criteria for inclusion and exclusion</title><p>A study had to fulfill the following criteria for inclusion: (1) Randomized and non-randomized studies that compared the perioperative outcomes of RRC and LRC, regardless of the diseases of the right-side colon; (2) if the same institution and/or authors reported more than one study, the higher-quality study or the most recent publication was included; And (3) studies that were included had to report at least one of the following outcomes: operative time, estimated blood loss, length of hospital stay, conversion rate to open surgery, postoperative complications, and related outcomes.</p><p>The reasons for exclusion were the following: (1) the perioperative outcomes and patient characteristics were not reported clearly; (2) there were overlaps between authors or institutions in the published literature; or (3) studies lacked controls.</p></sec><sec id="Sec6"><title>Statistical analysis</title><p>The meta-analysis was performed using the Review Manager software (RevMan, version 5.2, Copenhagen: Nordic Cochrane Centre, Cochrane Collaboration, 2012) that was provided by the Cochrane Collaboration. Continuous variables were pooled using the mean difference (MD) with a 95% confidence interval (95% CI), and dichotomous variables were pooled using the odds ratio (OR) with a 95% CI. If studies reported only the median, range, and size of the trial, the means and standard deviations were calculated according to Hozo <italic>et al</italic>. [<xref ref-type="bibr" rid="CR8">8</xref>]. If data reported only the medians, this parameter was included. Statistical heterogeneity was evaluated by I<sup>2</sup>, and it was considered to be high if the I<sup>2</sup> statistic was greater than 50%. The fixed effects model was used for studies with low or moderate statistical heterogeneity, and the random effects model was used for studies with high statistical heterogeneity. Sensitivity analysis was performed by repeating the meta-analysis on the studies that were excluded.</p></sec></sec><sec id="Sec7" sec-type="results"><title>Results</title><sec id="Sec8"><title>Eligible studies</title><p>Following the search terms, 168 publications were initially retrieved. After carefully screening the titles, abstracts, and full text, eight comparative studies [<xref ref-type="bibr" rid="CR9">9</xref>–<xref ref-type="bibr" rid="CR16">16</xref>] remained in the analysis. However, one comparative study by Shin [<xref ref-type="bibr" rid="CR9">9</xref>] was excluded because patient characteristics were not clearly reported in the right-sided colectomy subgroup and the study appeared noticeably different from the other studies. Finally, seven studies [<xref ref-type="bibr" rid="CR10">10</xref>–<xref ref-type="bibr" rid="CR16">16</xref>] that met all inclusion criteria were entered into this meta-analysis (Figure <xref rid="Fig1" ref-type="fig">1</xref>). These seven studies involved a total number of 649 patients: 234 in the RRC group and 415 in the LRC group. Of the seven studies, six were non-randomized controlled trials (NRCTs) and one was a randomized controlled trial (RCT). The baseline characteristics and quality assessment of these seven studies are listed in Table <xref rid="Tab1" ref-type="table">1</xref>. The robot-assisted hybrid technique was involved in all studies. Five studies were conducted in the United States [<xref ref-type="bibr" rid="CR10">10</xref>, <xref ref-type="bibr" rid="CR12">12</xref>–<xref ref-type="bibr" rid="CR15">15</xref>], one in Korea [<xref ref-type="bibr" rid="CR11">11</xref>], and one in Italy [<xref ref-type="bibr" rid="CR16">16</xref>]. The quality of all the studies was satisfactory. The results showed that RRC had longer operative times, lower estimated blood losses, shorter hospital stays, lower overall postoperative complications, and a significantly faster bowel function recovery. Outcomes between RRC and LRC are listed in Table <xref rid="Tab2" ref-type="table">2</xref>. There were no statistical differences in the sex composition (<italic>P</italic> = 0.65) and body mass index (BMI) (<italic>P</italic> = 0.13). However, the mean age was found to be statistically significant in favoring the RRC group (<italic>P</italic> = 0.001).<fig id="Fig1"><label>Figure 1</label><caption><p><bold>Flow diagram of study selection for the meta-analysis.</bold></p></caption><graphic xlink:href="12957_2014_1754_Fig1_HTML" id="d30e497"></graphic></fig></p><table-wrap id="Tab1"><label>Table 1</label><caption><p><bold>Characteristics of the seven studies selected for inclusion in the meta-analysis</bold></p></caption><table frame="hsides" rules="groups"><thead><tr><th>Study</th><th>Country</th><th>Group</th><th>Patients</th><th>Mean age</th><th>Mean BMI</th><th>Sex (M: F)</th><th>Study type</th><th>Anastomosis technique</th><th>Minors</th></tr></thead><tbody><tr><td rowspan="2">Lujan<italic>et al</italic>. [<xref ref-type="bibr" rid="CR10">10</xref>]</td><td rowspan="2">United States</td><td>RRC</td><td>22</td><td>71.88 ± 9.0</td><td>31.44 ± 6.02</td><td>8:14</td><td rowspan="2">PNR</td><td rowspan="2">Intracorporeal and Extracorporeal</td><td rowspan="2">16/24</td></tr><tr><td>LRC</td><td>25</td><td>72.6 ± 11.1</td><td>27.88 ± 6.1</td><td>10:15</td></tr><tr><td rowspan="2">Park <italic>et al</italic>. [<xref ref-type="bibr" rid="CR11">11</xref>]</td><td rowspan="2">Korea</td><td>RRC</td><td>35</td><td>62.8 ± 10 · 5</td><td>24.4 ± 2.5</td><td>14:21</td><td rowspan="2">RCT</td><td>Intracorporeal and</td><td rowspan="2">3/5</td></tr><tr><td>LRC</td><td>35</td><td>66.5 ± 11 · 4</td><td>23.8 ± 2.7</td><td>16:19</td><td>Extracorporeal</td></tr><tr><td rowspan="2">deSouza <italic>et al</italic>. [<xref ref-type="bibr" rid="CR12">12</xref>]</td><td rowspan="2">United States</td><td>RRC</td><td>40</td><td>71.35 ± 14.</td><td>27.33 ± 5.22</td><td>22:18</td><td rowspan="2">PNR</td><td rowspan="2">Extracorporeal</td><td rowspan="2">17/24</td></tr><tr><td>LRC</td><td>135</td><td>65.32 ± 18</td><td>26.57 ± 6.39</td><td>62:73</td></tr><tr><td rowspan="2">Deutsch<italic>et al</italic>. [<xref ref-type="bibr" rid="CR13">13</xref>]</td><td rowspan="2">United States</td><td>RRC</td><td>18</td><td>65.2 ± 12</td><td>25 ± 3.8</td><td>6:12</td><td rowspan="2">PNR</td><td rowspan="2">Extracorporeal</td><td rowspan="2">17/24</td></tr><tr><td>LRC</td><td>47</td><td>70.8 ± 14.6</td><td>28 ± 6.5</td><td>22:25</td></tr><tr><td rowspan="2">Rawlings <italic>et al</italic>. [<xref ref-type="bibr" rid="CR14">14</xref>]</td><td rowspan="2">United States</td><td>RRC</td><td>17</td><td>64.6 ± 11.7</td><td>25.7 ± 4.3</td><td>8:9</td><td rowspan="2">R</td><td rowspan="2">Intracorporeal</td><td rowspan="2">14/24</td></tr><tr><td>LRC</td><td>15</td><td>63.1 ± 17.5</td><td>28.3 ± 6.4</td><td>6:9</td></tr><tr><td rowspan="2">Casillas [<xref ref-type="bibr" rid="CR15">15</xref>]</td><td rowspan="2">United States</td><td>RRC</td><td>52</td><td>65 ± 12</td><td>26.9(25.6-28.3)</td><td>25:27</td><td rowspan="2">PNR</td><td rowspan="2">Extracorporeal</td><td rowspan="2">14/24</td></tr><tr><td>LRC</td><td>110</td><td>71 ± 12</td><td>27.0(26.128.1)</td><td>79:41</td></tr><tr><td>Morpurgo [<xref ref-type="bibr" rid="CR16">16</xref>]</td><td>Italy</td><td>RRC</td><td>48</td><td>68 ± 8</td><td>25 ± 3.5</td><td>27:21</td><td>PNR</td><td>Intracorporeal</td><td>16/24</td></tr><tr><td></td><td></td><td>LRC</td><td>48</td><td>74 ± 11</td><td>28 ± 4</td><td>16:32</td><td></td><td></td><td></td></tr></tbody></table><table-wrap-foot><p>RRC, robotic right colectomy; LRC, laparoscopic right colectomy; PNR, prospective not randomized; R, retrospective; RCT, randomized controlled trial.</p></table-wrap-foot></table-wrap><table-wrap id="Tab2"><label>Table 2</label><caption><p><bold>Comparatives outcomes between RRC and LRC</bold></p></caption><table frame="hsides" rules="groups"><thead><tr><th></th><th>No of studies</th><th>RRC</th><th>LRC</th><th>MD/OR</th><th>95% CI</th><th>P</th><th>I
<sup>2</sup></th></tr></thead><tbody><tr><td><bold>Characteristics</bold></td><td align="center"></td><td align="center"></td><td align="center"></td><td align="center"></td><td align="center"></td><td align="center"></td><td align="center"></td></tr><tr><td>Age</td><td align="center">7</td><td align="center">234</td><td align="center">415</td><td align="center">-3.21</td><td align="center">[-5.16 - –1.26]</td><td align="center">0.001</td><td align="center">65%</td></tr><tr><td>Gender ratio</td><td align="center">7</td><td align="center">234</td><td align="center">415</td><td align="center">0.93</td><td align="center">[0.67 - 1.29 ]</td><td align="center">0.65</td><td align="center">62%</td></tr><tr><td>BMI</td><td align="center">7</td><td align="center">234</td><td align="center">415</td><td align="center">-0.54</td><td align="center">[-1.24 - 0.16]</td><td align="center">0.13</td><td align="center">77%</td></tr><tr><td colspan="2"><bold>Intraoperative outcomes</bold></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Operative time (minutes)</td><td align="center">7</td><td align="center">234</td><td align="center">415</td><td align="center">51.57</td><td align="center">[28.82 - 67.66]</td><td align="center"><0.00001</td><td align="center">90%</td></tr><tr><td>Blood loss (mL)</td><td align="center">6</td><td align="center">186</td><td align="center">367</td><td align="center">-18.79</td><td align="center">[-28.7 - –8.88]</td><td align="center">0.0002</td><td align="center">20%</td></tr><tr><td>Conversion to open surgery</td><td align="center">5</td><td align="center">168</td><td align="center">320</td><td align="center">0.69</td><td align="center">[0.26 - 1.89]</td><td align="center">0.48</td><td align="center">7%</td></tr><tr><td colspan="2"><bold>Postoperative outcomes</bold></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Hospital stay (days)</td><td align="center">7</td><td align="center">199</td><td align="center">334</td><td align="center">-0.41</td><td align="center">[-0.93 - 0.1]</td><td align="center">0.12</td><td align="center">35%</td></tr><tr><td>Total complication</td><td align="center">7</td><td align="center">232</td><td align="center">415</td><td align="center">0.62</td><td align="center">[0.42 - 0.92]</td><td align="center">0.02</td><td align="center">0%</td></tr><tr><td>Anastomosis leakage</td><td align="center">7</td><td align="center">232</td><td align="center">415</td><td align="center">0.55</td><td align="center">[0.19 - 1.61]</td><td align="center">0.28</td><td align="center">21%</td></tr><tr><td>Postoperative ileus</td><td align="center">7</td><td align="center">232</td><td align="center">415</td><td align="center">0.53</td><td align="center">[0.25 - 1.08]</td><td align="center">0.08</td><td align="center">0%</td></tr><tr><td>Bleeding</td><td align="center">7</td><td align="center">232</td><td align="center">415</td><td align="center">0.97</td><td align="center">[0.37 - 2.57]</td><td align="center">0.95</td><td align="center">2%</td></tr></tbody></table></table-wrap></sec><sec id="Sec9"><title>Operating time</title><p>The operating time was reported in all seven studies [<xref ref-type="bibr" rid="CR10">10</xref>–<xref ref-type="bibr" rid="CR16">16</xref>], six of which supported the finding that operating times were longer in RRC. The study by Deutsch <italic>et al</italic>. [<xref ref-type="bibr" rid="CR13">13</xref>] was the only one showing no differences between the two approaches. In this study, undocking time was not included in the operating time. Because of the high heterogeneity (I<sup>2</sup> = 90%) of these studies, the random effects model was used for the meta-analysis. The results show that the RRC group had a significantly longer operating time compared to the LRC group (MD = 48.24; 95% CI: 28.82 - 67.66; <italic>P</italic> < 0.00001). Analysis excluding the data from the study by Deutsch <italic>et al</italic>. [<xref ref-type="bibr" rid="CR13">13</xref>] still shows a significant statistical difference in operating time that favors RRC (MD = 57.83; 95% CI:51.88 - 63.78; <italic>P</italic> < 0.00001), and the heterogeneity is still high (I<sup>2</sup> = 90%;Figure <xref rid="Fig2" ref-type="fig">2</xref>).<fig id="Fig2"><label>Figure 2</label><caption><p><bold>Analysis of the operating time.</bold> Forest plot of comparison between robotic right colectomy and conventional laparoscopic right colectomy. instrumental variables (IV) is used to estimate causal relationships when controlled experiments are not feasible.</p></caption><graphic xlink:href="12957_2014_1754_Fig2_HTML" id="d30e1344"></graphic></fig></p></sec><sec id="Sec10"><title>Length of hospital stay</title><p>The length of hospital stay was reported in all seven studies [<xref ref-type="bibr" rid="CR10">10</xref>–<xref ref-type="bibr" rid="CR16">16</xref>]. Results of the meta-analysis show no differences between the RRC and the LRC groups (MD = -0.41; 95% CI: -0.93 -0.1; <italic>P</italic> = 0.12), with a low heterogeneity (I<sup>2</sup> = 35%;Figure <xref rid="Fig3" ref-type="fig">3</xref>).<fig id="Fig3"><label>Figure 3</label><caption><p><bold>Analysis of the length of hospital stay.</bold> Forest plot of comparison between robotic right colectomy and conventional laparoscopic right colectomy. instrumental variables (IV) is used to estimate causal relationships when controlled experiments are not feasible.</p></caption><graphic xlink:href="12957_2014_1754_Fig3_HTML" id="d30e1377"></graphic></fig></p></sec><sec id="Sec11"><title>Conversion to open surgery</title><p>The conversion rate to open surgery was reported in five studies [<xref ref-type="bibr" rid="CR10">10</xref>–<xref ref-type="bibr" rid="CR12">12</xref>, <xref ref-type="bibr" rid="CR14">14</xref>, <xref ref-type="bibr" rid="CR15">15</xref>]. Results of the meta-analysis show no differences between the RRC and the LRC groups (OR = 0.69, 95% CI: 0.26 - 1.89; <italic>P</italic> =0.48), with a low heterogeneity (I<sup>2</sup> = 7%).</p></sec><sec id="Sec12"><title>Estimated blood loss</title><p>The estimated intraoperative blood loss was reported in six studies [<xref ref-type="bibr" rid="CR10">10</xref>–<xref ref-type="bibr" rid="CR15">15</xref>]. Results of the meta-analysis show that intraoperative estimated blood loss was significantly lower in patients from the RRC group as compared to patients undergoing LRC (MD = -18.79; 95% CI: -28.7 - –8.88; P = 0.0002), with a low observed heterogeneity (I<sup>2</sup> = 20%; Figure <xref rid="Fig4" ref-type="fig">4</xref>).<fig id="Fig4"><label>Figure 4</label><caption><p><bold>Analysis of the estimated blood loss.</bold> Forest plot of comparison between robotic right colectomy and conventional laparoscopic right colectomy instrumental variables (IV) is used to estimate causal relationships when controlled experiments are not feasible.</p></caption><graphic xlink:href="12957_2014_1754_Fig4_HTML" id="d30e1430"></graphic></fig></p></sec><sec id="Sec13"><title>Time to bowel function recovery</title><p>Time to bowel function recovery was reported in three studies [<xref ref-type="bibr" rid="CR10">10</xref>, <xref ref-type="bibr" rid="CR11">11</xref>, <xref ref-type="bibr" rid="CR13">13</xref>]. Results of the meta-analysis show that bowel function recovered much faster in patients undergoing RRC than in those undergoing LRC (MD = -0.79; 95% CI: -1.10 - –0.48;, <italic>P</italic> < 0.000001), with a low heterogeneity (I<sup>2</sup> = 26%).</p></sec><sec id="Sec14"><title>Overall postoperative complications</title><p>Overall postoperative complications were reported in six studies [<xref ref-type="bibr" rid="CR10">10</xref>–<xref ref-type="bibr" rid="CR16">16</xref>]. Results of the meta-analysis show that overall complications in the RRC group were significantly fewer than in the LRC group. (MD = 0.62; 95% CI: 0.42 - 0.92; <italic>P</italic> = 0.02), with no observed heterogeneity (I<sup>2</sup> = 0%). In terms of postoperative ileus, the meta-analysis shows no difference between the two groups (MD = 0.53; 95% CI:0.25 -1.08; <italic>P</italic> = 0.08) with no heterogeneity (I<sup>2</sup> = 0%). The meta-analysis also shows no difference between the two groups in terms of anastomosis leakage (MD = 0.55; 95% CI: 0.19 -1.61; <italic>P</italic> = 0.28) and postoperative bleeding (MD = 0.97; 95% CI: 0.37 -2.57; <italic>P</italic> = 0.95), with a low heterogeneity (I<sup>2</sup> = 21% and 2%, respectively; Figure <xref rid="Fig5" ref-type="fig">5</xref>).<fig id="Fig5"><label>Figure 5</label><caption><p><bold>Analysis of overall postoperative complications.</bold> Forest plot of comparison between robotic right colectomy and conventional laparoscopic right colectomy. Meta-analyses of dichotomous variables were performed using the Mantel–Haenszel (M-H) method.</p></caption><graphic xlink:href="12957_2014_1754_Fig5_HTML" id="d30e1498"></graphic></fig></p></sec></sec><sec id="Sec15" sec-type="discussion"><title>Discussion</title><p>After being first described in 1991, laparoscopic colorectal surgery has rapidly evolved in recent years [<xref ref-type="bibr" rid="CR17">17</xref>]. Currently, most colorectal procedures are performed laparoscopically. Several studies show that laparoscopic colorectal surgery is associated with better short-term outcomes than open surgery, and the benefits include smaller incisions, reduced postoperative pain and duration of ileus, faster postoperative recovery, shorter hospital stay, and earlier recovery of normal activity [<xref ref-type="bibr" rid="CR18">18</xref>, <xref ref-type="bibr" rid="CR19">19</xref>]. However, the laparoscopic approach has several limitations such as tremor, loss of three-dimensional view, inability to perform high-precision suturing, poor ergonomics, fixed tips, and limited movement dexterity [<xref ref-type="bibr" rid="CR20">20</xref>]. The da Vinci surgical system has been developed to overcome such difficulties and has become increasingly popular in colorectal surgery. The system is equipped with a three-dimensional high-definition camera, and is capable of physiological tremor filtration. Furthermore, it enables three extra degrees of movement by using articulated instruments. Therefore, it can minimize the risk of injury to vessels and nerve structures and provide oncological resection capabilities [<xref ref-type="bibr" rid="CR21">21</xref>]. Furthermore, the surgical system can also decrease the learning curve for laparoscopic surgery [<xref ref-type="bibr" rid="CR22">22</xref>]. However, there are also limitations of this system such as the loss of haptic feedback, limited range of movement of the robotic arms and, in addition, it is time-consuming and high-cost. The limited intracorporeal range of motion is the major drawback in colectomy when operating in a large operative field [<xref ref-type="bibr" rid="CR23">23</xref>]. Up to now, several studies [<xref ref-type="bibr" rid="CR9">9</xref>–<xref ref-type="bibr" rid="CR16">16</xref>] have compared the safety and efficacy of RRC and conventional LRC, but no meta-analyses were performed to compare and integrate the results of these studies. To the best of our knowledge, this is the first comprehensive meta-analysis comparing RRC and LRC.</p><p>Although RCTs are usually applied and supposed to be used [<xref ref-type="bibr" rid="CR24">24</xref>] in meta-analyses, this is not always possible or feasible in surgical research studies [<xref ref-type="bibr" rid="CR25">25</xref>]. Therefore, meta-analyses using NRCTs might be a good method for surgical trials, and most of the available evidence in surgery comes from non-randomized studies [<xref ref-type="bibr" rid="CR7">7</xref>]. However, selection bias exists in these studies because most of the studies are not randomized and preoperative characteristics are not equal across some of the studies. High heterogeneity may not provide useful meta-analysis results. However, it is the impact of factors other than the surgical approach that affect these outcomes. The present meta-analysis points towards the apparent feasibility of RRC. The pooled results of the seven studies showed that RRC had longer operative times, lower estimated blood loss, shorter hospital stays, lower overall postoperative complications, and a significantly faster bowel function recovery.</p><p>A long operative time was widely reported in robotic colorectal surgery. Many factors influence operative times, and these include set-up time, docking time, learning curve, and the type of anastomosis [<xref ref-type="bibr" rid="CR26">26</xref>]. In terms of right colectomy, either a hybrid technique or repositioning of the robotic cart is required [<xref ref-type="bibr" rid="CR27">27</xref>]. Multiple dockings of the robotic cart and the creation of a proper surgical field are also time-consuming. The set-up time was excluded from all the seven studies included in the meta-analysis. Operative time was reported to be longer in RRC than in LRC in most of the studies, except for the study by Deutsch <italic>et al</italic>. [<xref ref-type="bibr" rid="CR13">13</xref>]. This meta-analysis indicates that the operative time in patients from the RRC group was significant longer than in the LRC group. The heterogeneity of the operative time between the approaches was very high (I<sup>2</sup> = 90%). The reasons for this high heterogeneity of the operating time are threefold. Firstly, different diseases of the right-side colon, such as cancer, diverticulitis, polyps, Crohn’s disease, and so on, were included in different studies. Furthermore, some studies included both benign and malignant diseases [<xref ref-type="bibr" rid="CR10">10</xref>, <xref ref-type="bibr" rid="CR12">12</xref>–<xref ref-type="bibr" rid="CR15">15</xref>], and some included only right-side colon cancer. Secondly, anastomosis techniques were different in the different studies, as shown in Table <xref rid="Tab1" ref-type="table">1</xref>. Thirdly, the learning curve in RRC occurred earlier than that in the LRC procedures. Therefore, the operating surgeon was commonly relatively inexperienced in RRC procedures. However, clinical and oncological outcomes improved significantly in laparoscopic surgery with the increase of experience [<xref ref-type="bibr" rid="CR28">28</xref>]. Furthermore, operative times in robotic colorectal surgery became shorter as the surgeon’s experience improved [<xref ref-type="bibr" rid="CR29">29</xref>]. We believe that outcomes in robotic surgery will significantly improve in the future.</p><p>We found less estimated intraoperative blood loss in patients undergoing RRC than that in those undergoing LRC. The three-dimensional high-definition field of view and augmented dexterity enabled surgeons to detect small structures and blood vessels, which contributed to the decreased blood loss. Reduced blood is also associated with reduced hospital stay and decreased conversion rates to open surgery.</p><p>Patients undergoing RRC recover their bowel function much faster than those undergoing LRC. This may be explained by the performance of intracorporeal anastomosis in the studies that we included. Intracorporeal anastomosis is proven to have several advantages, such as lower colon mobilization, fewer complications related to the exteriorization of the mesentery, and smaller incisions to extract the specimen [<xref ref-type="bibr" rid="CR30">30</xref>]. These advantages can minimize the damage to the intestine and enable faster bowel function recovery. Meanwhile, a small incision can reduce postoperative pain, surgical site infections, and incision hernia [<xref ref-type="bibr" rid="CR31">31</xref>]. Additionally, the major advantages of robotics are the three-dimensional view and the endo-wrist movements that facilitate intracorporeal suturing. The robotic-assisted intracorporeal anastomosis has been compared with extracorporeal anastomosis in the study by Morpurgo <italic>et al</italic>. [<xref ref-type="bibr" rid="CR16">16</xref>]. Anastomotic complications were observed in the LRC with extracorporeal anastomosis and none in the RRC. Meanwhile, the extracorporeal anastomosis group have a significantly higher risk of incisional hernia than the intracorporeal anastomosis group.</p><p>In our meta-analysis, there were significantly fewer overall complications in the RRC group, which can be explained by the higher age of patients from the LRC group. At the same time, a good field of vision and precise movements may minimize the risk of tissue injuries and, finally, lead to fewer complications. However, in terms of postoperative ileus, anastomotic leakage, and postoperative bleeding, the meta-analysis shows no differences between the two groups. More advanced studies are still needed to verify this conclusion.</p><p>A major drawback of robotic rectal surgery is its high cost. The cost was not taken into account when performing the comparison because only two studies [<xref ref-type="bibr" rid="CR11">11</xref>, <xref ref-type="bibr" rid="CR12">12</xref>] provided these data. In the two studies, total costs were significantly higher for RRC than for LRC. Baek<italic>et al</italic>. reported that the total cost in robotic surgery was approximately 1.5 times higher than in the laparoscopic group [<xref ref-type="bibr" rid="CR32">32</xref>]. A recent systematic review also showed that robot-assisted laparoscopic resection had significant higher costs and longer operative times than traditional laparoscopic resections, but no measurable benefits were obtained [<xref ref-type="bibr" rid="CR33">33</xref>].</p><p>Several limitations existed in the present meta-analysis. Firstly, the studies included in this meta-analysis consisted of one randomized controlled trial and six non-randomized controlled trials, and NRCTs can bias the interpretation of results in spite of quality scores [<xref ref-type="bibr" rid="CR34">34</xref>]. Secondly, the included studies had relatively limited numbers of patients, and it was difficult to perform subgroup analyses. Thirdly, this meta-analysis could not interpret the problems caused by confounding factors that were inherent to the included studies. Finally, it was impossible to match the characteristics of the patients in most of the studies, and heterogeneity exists in the two groups.</p></sec><sec id="Sec16" sec-type="conclusions"><title>Conclusions</title><p>In conclusion, this meta-analysis suggests that RRC has longer operative times, lower estimated blood losses, shorter hospital stays, lower rates of overall postoperative complications, and a significantly faster bowel function recovery. Other clinical and oncological outcomes appear to be equivalent. Future well-designed prospective RCTs are required to better define this technique.</p></sec></body><back><glossary><title>Abbreviations</title><def-list><def-list><def-item><term>BMI</term><def><p>Body mass index</p></def></def-item><def-item><term>LRC</term><def><p>Laparoscopic right colectomy</p></def></def-item><def-item><term>MD</term><def><p>Mean difference</p></def></def-item><def-item><term>MeSH</term><def><p>Medical subject headings</p></def></def-item><def-item><term>NRCTs</term><def><p>Non-randomized controlled trials</p></def></def-item><def-item><term>OR</term><def><p>Odds ratio</p></def></def-item><def-item><term>RCT</term><def><p>Randomized controlled trial</p></def></def-item><def-item><term>RRC</term><def><p>Robotic right colectomy.</p></def></def-item></def-list></def-list></glossary><fn-group><fn><p><bold>Competing interests</bold></p><p>The authors declare that they have no competing interests.</p></fn><fn><p><bold>Authors’ contributions</bold></p><p>HRX: study design, data acquisition, analysis and interpretation, critical revision; JNL: data acquisition,analysis and interpretation, critical revision,manuscript writing; YLS: study design, data analysis and interpretation, manuscript drafting, critical revision; ZJL: data analysis and interpretation, manuscript writing; YNZ and BW: data analysis and interpretation; ZFX: study concept and design, data analysis and interpretation, critical revision, supervision. 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