title: Robotic versus laparoscopic colorectal surgery.
abstract: BACKGROUND
  Robotic approaches have become increasingly used for colorectal surgery. The aim of this study is to examine the safety and efficacy of robotic colorectal procedures in an adult population.
  
  
  METHODS
  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 included. 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 patients: 920 robotic and 3,422 in the laparoscopic group. Operative time for the robotic approach was 38.849 minutes 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 patients 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, readmission 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 warranted to examine the cost-effectiveness of robotic colorectal surgery before it can be adopted as the new standard of care.
authors.affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
authors.forename: Becky B
authors.initials: BB
authors.lastname: Trinh
authors.affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
authors.forename: Nicole R
authors.initials: NR
authors.lastname: Jackson
authors.affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
authors.forename: Adam T
authors.initials: AT
authors.lastname: Hauch
authors.affiliation: Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA.
authors.forename: Tian
authors.initials: T
authors.lastname: Hu
authors.affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
authors.forename: Emad
authors.initials: E
authors.lastname: Kandil
mesh_terms: D003107:Colorectal Surgery / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D061646:Operative Time; D012371:Robotics / Q000379:methods*
keywords: Colorectal surgery; Laparoscopic; Robotic