title: Laparoscopic versus robotic-assisted colectomy and rectal resection: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Lately, the main technical innovations in the field of colorectal surgery have been the introduction of laparoscopic and robotic techniques; the aim of this study is to investigate the results and the advantages of these two surgical approaches.
  
  
  METHODS
  Twenty-two studies including 1652 laparoscopic and 1120 robotic-assisted resections were analyzed and categorized into right, left, and pelvic resections of the middle/low rectum, aiming to the following outcomes: operating time, blood loss, bowel function recovery, return to oral intake, morbidity, hospital stay, and costs.
  
  
  RESULTS
  The vast majority of the studies were non-randomized investigations (19/22 studies) enrolling small cohorts of patients (median 55.0 laparoscopic and 34.5 robotic-assisted group) with a mean age of 62.2-61.0 years. Funnel plot analysis documented heterogeneity in studies which combined cancers and benign diseases. Our meta-analysis demonstrated a significant difference in favor of laparoscopic procedures regarding costs and operating time (standardized mean difference (SMD) 0.686 and 0.493) and in favor of robotic surgery concerning morbidity rate (odds ratio (OR) 0.763), although no benefits were documented when analyzing exclusively randomized trials. When we differentiated approaches by side of resections, a significant difference was found in favor of the laparoscopic group when analyzing operating time in left-sided and pelvic procedures (SMD 0.609 and 0.529) and blood loss in pelvic resections (SMD 0.339).
  
  
  CONCLUSIONS
  Laparoscopic techniques were documented as the shorter procedures, which provided lower blood loss in pelvic resections, while morbidity rate was more favorable in robotic surgery. However, these results could not be confirmed when we focused the analysis on randomized trials only.
authors.affiliation: Surgical and Medical Department of Traslational Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Via di Grottarossa 1035-39, 00189, Rome, Italy. laura.lorenzon@uniroma1.it.
authors.forename: Laura
authors.initials: L
authors.lastname: Lorenzon
authors.affiliation: Department of Mechanical and Aerospace Engineering, "Sapienza" University of Rome, via Eudossiana 18, 00184, Rome, Italy.
authors.forename: Fabiano
authors.initials: F
authors.lastname: Bini
authors.affiliation: Surgical and Medical Department of Traslational Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Via di Grottarossa 1035-39, 00189, Rome, Italy.
authors.forename: Genoveffa
authors.initials: G
authors.lastname: Balducci
authors.affiliation: Surgical and Medical Department of Traslational Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Via di Grottarossa 1035-39, 00189, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Ferri
authors.affiliation: Surgical and Medical Department of Traslational Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Via di Grottarossa 1035-39, 00189, Rome, Italy.
authors.forename: Pier Federico
authors.initials: PF
authors.lastname: Salvi
authors.affiliation: Department of Mechanical and Aerospace Engineering, "Sapienza" University of Rome, via Eudossiana 18, 00184, Rome, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Marinozzi
mesh_terms: D016063:Blood Loss, Surgical; D003082:Colectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D003108:Colonic Diseases / Q000601:surgery; D015179:Colorectal Neoplasms / Q000601:surgery; D017721:Hospital Costs; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D007902:Length of Stay; D008197:Lymph Node Excision; D061646:Operative Time; D020127:Recovery of Function; D012002:Rectal Diseases / Q000601:surgery; D012007:Rectum / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000191:economics
keywords: Colorectal cancer; Laparoscopy; Meta-analysis; Robotic surgery