J Gastrointest Surg DOI 10.1007/s11605-014-2469-5
ORIGINAL ARTICLE
Outcomes of Robotic-Assisted Colorectal Surgery Compared with Laparoscopic and Open Surgery: a Systematic Review Chang Woo Kim & Chang Hee Kim & Seung Hyuk Baik
Received: 18 August 2013 / Accepted: 20 January 2014 # 2014 The Society for Surgery of the Alimentary Tract
Abstract Background Robotic technology has been applied to colorectal surgery over the last decade. The aim of this review is to analyze the outcomes of robotic colorectal surgery systematically and to provide objective information to surgeons. Methods Studies were searched and identified using PubMed and Google Scholar from Jan 2001 to Feb 2013 with the search terms “robot,” “robotic,” “colon,” “rectum,” “colorectal,” and “colectomy.” Appropriate data in the studies about the outcomes of robotic colorectal surgery were analyzed. Results Sixty-nine publications were included in this review and composed of 39 case series, 29 comparative studies, and 1 randomized controlled trial. Most of the studies reported that robotic surgery showed a longer operation time, less estimated blood loss, shorter length of hospital stay, lower complication and conversion rates, and comparable oncologic outcomes compared to laparoscopic or open surgery. Conclusion Robotic colorectal surgery is a safe and feasible option. Robotic surgery showed comparable short-term outcomes compared to laparoscopic surgery or open surgery. However, the long operation time and high cost are the limitations of robotic surgery. Keywords Systematic review . Robotic surgery . da Vinci . Colon cancer . Rectal cancer
Introduction Minimally, invasive surgery has come into the territory of gastrointestinal surgery, and now it has already been over 20 years as the first laparoscopic colorectal surgery was performed successfully.1 From then, a number of surgeons reported the advantages of laparoscopic surgery (LS) compared to conventional open surgery (OS). There were not only better cosmetic results, less postoperative pain, reduced length of hospital stay (LOS), and shorter time to recover normal bowel – function and start diet but also similar oncologic outcomes.2 5 Moreover, the development of the newly applied robotic system starting with the first robotic colorectal surgery in C. W. Kim : C. H. Kim : S. H. Baik (*) Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea e-mail: [email protected]
2001 has been remarkable.6 The only commercially available robotic platform currently, the da Vinci system (Intuitive Surgical, Inc., Sunnyvale, CA, USA), has many advantages such as three-dimensional vision, 7° of wrist-like motion, tremor filtering, motion scaling, better ergonomics, and less fatigue. These technological advantages can help to overcome the disadvantages of LS such as two-dimensional vision, – limited dexterity, and tremors.7 9 However, robotic surgery (RS) has several drawbacks such as the lack of haptic sense, bulky robotic cart, and high cost.10 Moreover, there were no sufficient studies in terms of oncologic safety. Thus, this systematic review aimed to evaluate the objective results of robotic colorectal surgery and provide a comprehensive analysis of RS to surgeons who are performing robotic surgery or have a plan to adopt robotic system for colorectal surgery.
Methods Electronic literatures were searched and identified using PubMed and Google Scholar from January 2001 to February 2013 with the search terms “robot,” “robotic,” “colon,” “rectum,”
J Gastrointest Surg
“colorectal,” and “colectomy.” Then an additional search was done manually in the reference lists of obtained relevant publications. The inclusion criteria were case series, retrospective or prospective comparative studies, and randomized controlled trials (RCT) with appropriate data. Reviews, letters, and articles describing robotic technology or animal experiments; case reports; comparative studies with inappropriate data; and nonEnglish language articles were excluded (Fig. 1). The first author; country represented by the nationality of the author; year of publication; type of study; robotic platform; number, sex, age, and body mass index (BMI) of patients; diseases whether benign or malignant; operation type; operation time (OT); estimated blood loss (EBL); LOS; postoperative pain; time to bowel function recovery or first flatus; time to start diet; intraoperative and postoperative complications; conversion rates to OS or LS; and oncologic outcomes were classified in all the included studies. The outcomes were analyzed separately according to the operation types. Although the first authors were different, data of the same operation type that underwent the same period at the same hospital or university were considered as duplicates. When they were identified, the only studies which had the largest patient group, most parameters reported or most recent data were chosen and included.
Results Literature Search The literature search yielded 207 titles and the process is listed in Fig. 1. After the first filtering, the remaining 93 studies were 51 case series, 40 comparative studies, and 2 RCTs. Then, 24 Fig. 1 Flow diagram of literature search
studies were excluded due to duplicated data. They were 12 case series, 11 comparative studies, and 1 RCT, and thus a total of 69 papers were finally reviewed systematically.
Characteristics The quantity of publications about robotic colorectal surgery has been increasing constantly. There were only three case series at the beginning in 2002, but we can find 17 studies in 2012 among the total of 69 studies (Table 1). With regard to the nationality of the first author, there were 20 studies in the USA (29.0 %), 14 in the Republic of Korea (20.3 %), 12 in Italy (17.4 %), 3 each in Canada and the Netherlands (4.3 %), 2 each in France, Germany, Singapore, Switzerland, and Turkey (2.9 %) that were published, and followed by 1 study in Austria, China, Denmark, Japan, Malaysia, Romania, and the UK (1.4 %). A total of 2,644 operations were reported in the 69 publications. Among them, 1,445 males (54.7 %) and 1,092 females (45.3 %) were identified in 62 sex-reported studies. Sixty agereported studies showed an average age of 60.1±6.2 in 2,478 patients. Forty-six BMI-reported studies showed a mean BMI of 25.6±1.8 kg/m2 in 2,269 patients. Four hundred ninety-nine benign diseases (19.3 %) and 2,089 malignant diseases (80.7 %) were reported in 65 studies (Table 1). Sixty-six studies reported the type of operations: Nine hundred sixty-six low anterior resections (37.8 %), 387 right colectomies (15.2 %), 385 anterior resections (15.1 %), 268 intersphincteric resections (10.5 %), 170 sigmoid colectomies (6.7 %), 168 abdominoperineal resections (6.6 %), 104 rectopexies (4.1 %), 70 left colectomies (2.7 %), and 36 total or subtotal colectomies or proctocolectomies (1.4 %).
J Gastrointest Surg Table 1 Characteristics of publications Year Author
Type of Platform No. of Benign Malignancy M study Patient
F
Age (years)
BMI (kg/m2)
Operation type
2002 Hashizume M.11
CS
DV
3
0
3
1
2
76±7.9
NR
IC/LC/SC
2002 Weber P.A.12
CS
DV
2
2
0
1
1
46.5±4.9
25.8±1.3
RC/SC
2002 Talamini M.13
CS
DV
18
NR
NR
7
11
52
NR
NR
2003 Delaney C.P.14
CS
DV
6
4
2
2
4
58.1±17.8
31±7.7
2 RC/3 SC/RP
2003 Guilianotti P.C.15
CS
DV
16
2
14
NR
NR
NR
NR
2 IC/5 RC/LC/6 AR/2 APR
2003 Vibert E.16
CS
DV
3
2
1
2
1
69±3
NR
SC/Proct?/Hartmann reversal
2004 Anvari M.17
Comp
Zeus
10
4
6
3
7
68.7±6.13
NR
5 RC/LC/SC/2 AR/ToS
2004 D’Annibale A.18
Comp
DV
53
31
22
25
28
NR
NR
10 RC/17 LC/11 SC/10 AR/APR/2 ToS/RP/ Hartmann
2004 Munz Y.19
CS
DV
6
6
0
1
5
65 (37–87)
NR
6 RP
2005 Anvari M.20
CS
Zeus
6
NR
NR
NR
NR
NR
NR
2 RC/3 SC/AR
2005 Bodner J.21
CS
DV
14
11
3
NR
NR
NR
NR
NR
2005 Braumann C.22
CS
DV
5
2
3
2
3
70.2±10.9
26.6±3.8
RC/2 SC/2 AR
2005 Ruurda J.P.23
CS
DV
23
NR
NR
4
19
NR
NR
5 IC/16 RP/2 Sigmoid colostomy
2005 Woeste G.24
Comp
DV
6
6
0
NR
NR
NR
NR
4 SC/2 RP
2006 Ballantyne G.H.25
Comp1) DV
8
0
8
7
1
64 (43–71)a
27 (22–34)a
16 RC
8
0
8
3
5
56 (39–68)a
25 (20–32)a
26
2006 Denoto G.
CS
DV
11
NR
NR
7
4
46.5±13.7
28.5±5.5
2006 Sebajang H.27
CS
Zeus
7
4
3
NR
NR
NR
NR
3 RC/3 SC/LAR
2007 Heemskerk J.28
Comp
DV
19
19
0
7
12
55
NR
19 RP
2008 Soravia C.29
CS
DV
40
34
6
NR
NR
60 (32–84)
22 (19–40)
IC/3 RC/28 SC/AR/2 LAR/APR/3 RP/ Rectovaginal nodule resection
2008 Spinoglio G.30
Comp
DV
50
6
44
32
18
66.7
NR
18 RC/TC/10 LC/19 AR/APR/ToS
2009 Baik S.H.31
Comp
DV
56
0
56
37
19
60.3±8.3
23.4±3.1
56 LAR
2009 Choi D.J.32
CS
DVs
50
0
50
32
18
58.5±11.9
23.2±2.1
40 LAR/8 ISR/2 APR
2009 Choi G.S.33
CS
DVs
13
0
13
6
7
53.6±12.8
NR
13 LAR
2009 de Hoog D.E.34
Comp
DV
20
20
0
NR
NR
NR
NR
20 RP
2009 Luca F.35
CS
DV
55
0
55
34
21
63±9.9
25.2 (17.7–36)
27 LC/17 AR/4 ISR/7 APR
2009 Ng K.H.36
CS
DV
8
1
7
5
3
59.4±14
NR
2 AR/6 LAR
2009 Ostrowitz M.B.37
CS
DVs
3
2
1
2
1
77.3±4.2
NR
3 RC
2009 Patriti A.38
Comp
DV
29
0
29
11
18
68±10
24±6.2
3 AR/18 LAR/5 ISR/5 APR"
CS
DV
64
0
64
40
24
58 (26–83)a
26.8 (16.5-44)a
34 LAR/18 ISR/12 APR
a
18 AR/7 APR
2010 Baek J.H.39 40
11 SC
2010 Bianchi P.P.
Comp
DVs
25
0
25
18
7
69 (33–83)
24.6 (18.1–35)a
2010 D’Annibale A.41
CS
DV
50
0
50
24
26
73.3±11
25±3
50 RC
2010 deSouza A.L.42
CS
DVs
44
0
44
28
16
63
28.2 (17.6–43)a
30 LAR/6 ISR.8 APR
2010 Park J.S.43
Comp
DV
41
0
41
24
17
61.2±9.4
23.4±2.6
29 LAR/12 ISR
2010 Park Y.A.44
CS
DVs
45
0
45
30
15
61.5 (36–80) 23.6±3.1
42 LAR/3 APR
2010 Pigazzi A.45
CS
DV
143
0
143
87
56
62 (26–87)
26.5 (16.5–44)
80 LAR/32 ISR/31 APR
2010 Popescu, I.46
Comp
DVs
38
0
38
23
15
53±11.3
NR
30 AR/8 APR
2010 Zimmern A.47
CS
DV
131
66
67
66
67
62.4
27.3
42 RC/16 AR/47 LAR/11 APR/7 ToS/8 RP
2011 Bertani E.48
Comp2) DV
34
0
34
16
18
62.5±8.4
26.1±3.71
NR
52
0
52
31
21
59.6±11.6
24.8±3.62
48 LAR/4 APR
49
0
49
27
22
61.6±11.7
24.9±3.6
49 LAR
2011 Biffi R.49
Comp
DVs
J Gastrointest Surg Table 1 (continued) Year Author
Type of Platform No. of Benign Malignancy M study Patient
F
Age (years)
BMI (kg/m2)
Operation type
2011 Bokhari M.B.50
CS
DV
23
54.4±13.1
27.8±6.3
25 AR/15 LAR/6 APR/4 RP
2011 Buchs N.C.51
CS
DVs
3
2
1
1
2
72.7±12.7
25.7±6.7
3 RC
2011 Huettner F.52
CS
DV
102
83
19
49
53
63.5
27.4
59 RC/43 SC
2011 Koh D.C.53
CS
DV
21
2
19
13
8
NR
23.8±4.7
SC/7 AR/7 LAR/5 ISR/ APR
2011 Luca F.54
Comp
DV
33
0
33
16
17
65.2 (44–87) 25.4 (20–32)
33 RC
2011 Marecik S.J.55
CS
DV
5
0
5
3
2
63.4±13.6
5 APR
2011 Patel C.B.56
Comp
DVs
30
22
8
19
11
53.9±11
28.2±4.2
23 SC/6 LAR/RP
2011 Pedraza R.57
CS
DV
5
5
0
2
3
45.8±11.3
24.2±1.9
5 ToS
2011 Ragupathi M.58
CS
DVs
24
24
0
14
10
49.8±9.3
29.9±6.3
24 AR
2011 Wong M.T.59
Comp
DVs
23
23
0
0
23
61±11
24±4
23 RP
60
2012 Akmal Y.
3)
Comp
DV
50
28
22
27
23.4±6.1
40
0
40
24
16
61.8 (26–84) 25.9 (18–44)
22 LAR/12 ISR/6 APR
40
0
40
26
14
58.9 (24–85) 28.5 (22.1–43.3)
18 LAR/9 ISR/13 APR
2012 Alimoglu61
CS
DV
7
0
7
5
2
52.9 (32–88) NR
7 APR
2012 Baek S.J.62
Comp
DV
154
0
154
105
49
59.1±12.2
23.4±3.1
3 AR/104 LAR/36 ISR/11 APR
2012 Deutsch G.B.63
Comp4) DV
18
13
5
12
6
65.2±12
25±3.8
18 RC
61
58
3
32
29
54±12.7
29.1±5.1
58 AR/2 LAR/LC
2012 Kang C.Y.64
CS
DV
6
0
6
3
3
54.5 (26–75) 24.2 (17.6–28.3)
6 APR
2012 Kang J.65
Comp
DV
165
0
165
104
61
61.2±11.4
23.1±2.8
164 LAR/Hartmann
DV
30
0
30
17
13
54 (24–78)a
27.8 (19.8–34.2)a
27 LAR/3 APR
2012 Karahasanoglu T.66 CS 67
2012 Kim J.C.
Comp
DV
100
0
100
71
29
61±9
23.8±3.1
55 LAR/45 ISR
2012 Kim Y.W.68
Comp
DV
62
0
62
41
21
56±11
24.2±2.4
50 LAR/10 ISR/APR/ Hartmann
2012 Lim D.R.69
Comp
DV
34
0
34
23
11
59.6±8.4
24.8±2.1
34 AR
2012 Lim M.S.70
CS
DV
22
0
22
12
10
58.5 (35–70) NR
22 AR
2012 Miller A.T.71
Comp
DV
17
17
0
11
6
42.8±14.8
24.7±4.3
17 ToS
2012 Park I.J.72
CS
DVs
30
0
30
16
14
58 (46–64)a
27.6 (25–32)a
5 LAR/19 ISR/6 APR
2012 Park J.S.
RCT
DV
35
0
35
14
21
62.8±10.5
24.4±2.5
35 RC
2012 Park S.Y.74
Comp
DV
40
0
40
28
12
57.3±12.1
23.9±2.4
40 ISR
2012 Shin J.Y.75
Comp
DV
30
0
30
18
12
58.1±8.6
n=22>25, n=8
ORIGINAL ARTICLE
Outcomes of Robotic-Assisted Colorectal Surgery Compared with Laparoscopic and Open Surgery: a Systematic Review Chang Woo Kim & Chang Hee Kim & Seung Hyuk Baik
Received: 18 August 2013 / Accepted: 20 January 2014 # 2014 The Society for Surgery of the Alimentary Tract
Abstract Background Robotic technology has been applied to colorectal surgery over the last decade. The aim of this review is to analyze the outcomes of robotic colorectal surgery systematically and to provide objective information to surgeons. Methods Studies were searched and identified using PubMed and Google Scholar from Jan 2001 to Feb 2013 with the search terms “robot,” “robotic,” “colon,” “rectum,” “colorectal,” and “colectomy.” Appropriate data in the studies about the outcomes of robotic colorectal surgery were analyzed. Results Sixty-nine publications were included in this review and composed of 39 case series, 29 comparative studies, and 1 randomized controlled trial. Most of the studies reported that robotic surgery showed a longer operation time, less estimated blood loss, shorter length of hospital stay, lower complication and conversion rates, and comparable oncologic outcomes compared to laparoscopic or open surgery. Conclusion Robotic colorectal surgery is a safe and feasible option. Robotic surgery showed comparable short-term outcomes compared to laparoscopic surgery or open surgery. However, the long operation time and high cost are the limitations of robotic surgery. Keywords Systematic review . Robotic surgery . da Vinci . Colon cancer . Rectal cancer
Introduction Minimally, invasive surgery has come into the territory of gastrointestinal surgery, and now it has already been over 20 years as the first laparoscopic colorectal surgery was performed successfully.1 From then, a number of surgeons reported the advantages of laparoscopic surgery (LS) compared to conventional open surgery (OS). There were not only better cosmetic results, less postoperative pain, reduced length of hospital stay (LOS), and shorter time to recover normal bowel – function and start diet but also similar oncologic outcomes.2 5 Moreover, the development of the newly applied robotic system starting with the first robotic colorectal surgery in C. W. Kim : C. H. Kim : S. H. Baik (*) Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea e-mail: [email protected]
2001 has been remarkable.6 The only commercially available robotic platform currently, the da Vinci system (Intuitive Surgical, Inc., Sunnyvale, CA, USA), has many advantages such as three-dimensional vision, 7° of wrist-like motion, tremor filtering, motion scaling, better ergonomics, and less fatigue. These technological advantages can help to overcome the disadvantages of LS such as two-dimensional vision, – limited dexterity, and tremors.7 9 However, robotic surgery (RS) has several drawbacks such as the lack of haptic sense, bulky robotic cart, and high cost.10 Moreover, there were no sufficient studies in terms of oncologic safety. Thus, this systematic review aimed to evaluate the objective results of robotic colorectal surgery and provide a comprehensive analysis of RS to surgeons who are performing robotic surgery or have a plan to adopt robotic system for colorectal surgery.
Methods Electronic literatures were searched and identified using PubMed and Google Scholar from January 2001 to February 2013 with the search terms “robot,” “robotic,” “colon,” “rectum,”
J Gastrointest Surg
“colorectal,” and “colectomy.” Then an additional search was done manually in the reference lists of obtained relevant publications. The inclusion criteria were case series, retrospective or prospective comparative studies, and randomized controlled trials (RCT) with appropriate data. Reviews, letters, and articles describing robotic technology or animal experiments; case reports; comparative studies with inappropriate data; and nonEnglish language articles were excluded (Fig. 1). The first author; country represented by the nationality of the author; year of publication; type of study; robotic platform; number, sex, age, and body mass index (BMI) of patients; diseases whether benign or malignant; operation type; operation time (OT); estimated blood loss (EBL); LOS; postoperative pain; time to bowel function recovery or first flatus; time to start diet; intraoperative and postoperative complications; conversion rates to OS or LS; and oncologic outcomes were classified in all the included studies. The outcomes were analyzed separately according to the operation types. Although the first authors were different, data of the same operation type that underwent the same period at the same hospital or university were considered as duplicates. When they were identified, the only studies which had the largest patient group, most parameters reported or most recent data were chosen and included.
Results Literature Search The literature search yielded 207 titles and the process is listed in Fig. 1. After the first filtering, the remaining 93 studies were 51 case series, 40 comparative studies, and 2 RCTs. Then, 24 Fig. 1 Flow diagram of literature search
studies were excluded due to duplicated data. They were 12 case series, 11 comparative studies, and 1 RCT, and thus a total of 69 papers were finally reviewed systematically.
Characteristics The quantity of publications about robotic colorectal surgery has been increasing constantly. There were only three case series at the beginning in 2002, but we can find 17 studies in 2012 among the total of 69 studies (Table 1). With regard to the nationality of the first author, there were 20 studies in the USA (29.0 %), 14 in the Republic of Korea (20.3 %), 12 in Italy (17.4 %), 3 each in Canada and the Netherlands (4.3 %), 2 each in France, Germany, Singapore, Switzerland, and Turkey (2.9 %) that were published, and followed by 1 study in Austria, China, Denmark, Japan, Malaysia, Romania, and the UK (1.4 %). A total of 2,644 operations were reported in the 69 publications. Among them, 1,445 males (54.7 %) and 1,092 females (45.3 %) were identified in 62 sex-reported studies. Sixty agereported studies showed an average age of 60.1±6.2 in 2,478 patients. Forty-six BMI-reported studies showed a mean BMI of 25.6±1.8 kg/m2 in 2,269 patients. Four hundred ninety-nine benign diseases (19.3 %) and 2,089 malignant diseases (80.7 %) were reported in 65 studies (Table 1). Sixty-six studies reported the type of operations: Nine hundred sixty-six low anterior resections (37.8 %), 387 right colectomies (15.2 %), 385 anterior resections (15.1 %), 268 intersphincteric resections (10.5 %), 170 sigmoid colectomies (6.7 %), 168 abdominoperineal resections (6.6 %), 104 rectopexies (4.1 %), 70 left colectomies (2.7 %), and 36 total or subtotal colectomies or proctocolectomies (1.4 %).
J Gastrointest Surg Table 1 Characteristics of publications Year Author
Type of Platform No. of Benign Malignancy M study Patient
F
Age (years)
BMI (kg/m2)
Operation type
2002 Hashizume M.11
CS
DV
3
0
3
1
2
76±7.9
NR
IC/LC/SC
2002 Weber P.A.12
CS
DV
2
2
0
1
1
46.5±4.9
25.8±1.3
RC/SC
2002 Talamini M.13
CS
DV
18
NR
NR
7
11
52
NR
NR
2003 Delaney C.P.14
CS
DV
6
4
2
2
4
58.1±17.8
31±7.7
2 RC/3 SC/RP
2003 Guilianotti P.C.15
CS
DV
16
2
14
NR
NR
NR
NR
2 IC/5 RC/LC/6 AR/2 APR
2003 Vibert E.16
CS
DV
3
2
1
2
1
69±3
NR
SC/Proct?/Hartmann reversal
2004 Anvari M.17
Comp
Zeus
10
4
6
3
7
68.7±6.13
NR
5 RC/LC/SC/2 AR/ToS
2004 D’Annibale A.18
Comp
DV
53
31
22
25
28
NR
NR
10 RC/17 LC/11 SC/10 AR/APR/2 ToS/RP/ Hartmann
2004 Munz Y.19
CS
DV
6
6
0
1
5
65 (37–87)
NR
6 RP
2005 Anvari M.20
CS
Zeus
6
NR
NR
NR
NR
NR
NR
2 RC/3 SC/AR
2005 Bodner J.21
CS
DV
14
11
3
NR
NR
NR
NR
NR
2005 Braumann C.22
CS
DV
5
2
3
2
3
70.2±10.9
26.6±3.8
RC/2 SC/2 AR
2005 Ruurda J.P.23
CS
DV
23
NR
NR
4
19
NR
NR
5 IC/16 RP/2 Sigmoid colostomy
2005 Woeste G.24
Comp
DV
6
6
0
NR
NR
NR
NR
4 SC/2 RP
2006 Ballantyne G.H.25
Comp1) DV
8
0
8
7
1
64 (43–71)a
27 (22–34)a
16 RC
8
0
8
3
5
56 (39–68)a
25 (20–32)a
26
2006 Denoto G.
CS
DV
11
NR
NR
7
4
46.5±13.7
28.5±5.5
2006 Sebajang H.27
CS
Zeus
7
4
3
NR
NR
NR
NR
3 RC/3 SC/LAR
2007 Heemskerk J.28
Comp
DV
19
19
0
7
12
55
NR
19 RP
2008 Soravia C.29
CS
DV
40
34
6
NR
NR
60 (32–84)
22 (19–40)
IC/3 RC/28 SC/AR/2 LAR/APR/3 RP/ Rectovaginal nodule resection
2008 Spinoglio G.30
Comp
DV
50
6
44
32
18
66.7
NR
18 RC/TC/10 LC/19 AR/APR/ToS
2009 Baik S.H.31
Comp
DV
56
0
56
37
19
60.3±8.3
23.4±3.1
56 LAR
2009 Choi D.J.32
CS
DVs
50
0
50
32
18
58.5±11.9
23.2±2.1
40 LAR/8 ISR/2 APR
2009 Choi G.S.33
CS
DVs
13
0
13
6
7
53.6±12.8
NR
13 LAR
2009 de Hoog D.E.34
Comp
DV
20
20
0
NR
NR
NR
NR
20 RP
2009 Luca F.35
CS
DV
55
0
55
34
21
63±9.9
25.2 (17.7–36)
27 LC/17 AR/4 ISR/7 APR
2009 Ng K.H.36
CS
DV
8
1
7
5
3
59.4±14
NR
2 AR/6 LAR
2009 Ostrowitz M.B.37
CS
DVs
3
2
1
2
1
77.3±4.2
NR
3 RC
2009 Patriti A.38
Comp
DV
29
0
29
11
18
68±10
24±6.2
3 AR/18 LAR/5 ISR/5 APR"
CS
DV
64
0
64
40
24
58 (26–83)a
26.8 (16.5-44)a
34 LAR/18 ISR/12 APR
a
18 AR/7 APR
2010 Baek J.H.39 40
11 SC
2010 Bianchi P.P.
Comp
DVs
25
0
25
18
7
69 (33–83)
24.6 (18.1–35)a
2010 D’Annibale A.41
CS
DV
50
0
50
24
26
73.3±11
25±3
50 RC
2010 deSouza A.L.42
CS
DVs
44
0
44
28
16
63
28.2 (17.6–43)a
30 LAR/6 ISR.8 APR
2010 Park J.S.43
Comp
DV
41
0
41
24
17
61.2±9.4
23.4±2.6
29 LAR/12 ISR
2010 Park Y.A.44
CS
DVs
45
0
45
30
15
61.5 (36–80) 23.6±3.1
42 LAR/3 APR
2010 Pigazzi A.45
CS
DV
143
0
143
87
56
62 (26–87)
26.5 (16.5–44)
80 LAR/32 ISR/31 APR
2010 Popescu, I.46
Comp
DVs
38
0
38
23
15
53±11.3
NR
30 AR/8 APR
2010 Zimmern A.47
CS
DV
131
66
67
66
67
62.4
27.3
42 RC/16 AR/47 LAR/11 APR/7 ToS/8 RP
2011 Bertani E.48
Comp2) DV
34
0
34
16
18
62.5±8.4
26.1±3.71
NR
52
0
52
31
21
59.6±11.6
24.8±3.62
48 LAR/4 APR
49
0
49
27
22
61.6±11.7
24.9±3.6
49 LAR
2011 Biffi R.49
Comp
DVs
J Gastrointest Surg Table 1 (continued) Year Author
Type of Platform No. of Benign Malignancy M study Patient
F
Age (years)
BMI (kg/m2)
Operation type
2011 Bokhari M.B.50
CS
DV
23
54.4±13.1
27.8±6.3
25 AR/15 LAR/6 APR/4 RP
2011 Buchs N.C.51
CS
DVs
3
2
1
1
2
72.7±12.7
25.7±6.7
3 RC
2011 Huettner F.52
CS
DV
102
83
19
49
53
63.5
27.4
59 RC/43 SC
2011 Koh D.C.53
CS
DV
21
2
19
13
8
NR
23.8±4.7
SC/7 AR/7 LAR/5 ISR/ APR
2011 Luca F.54
Comp
DV
33
0
33
16
17
65.2 (44–87) 25.4 (20–32)
33 RC
2011 Marecik S.J.55
CS
DV
5
0
5
3
2
63.4±13.6
5 APR
2011 Patel C.B.56
Comp
DVs
30
22
8
19
11
53.9±11
28.2±4.2
23 SC/6 LAR/RP
2011 Pedraza R.57
CS
DV
5
5
0
2
3
45.8±11.3
24.2±1.9
5 ToS
2011 Ragupathi M.58
CS
DVs
24
24
0
14
10
49.8±9.3
29.9±6.3
24 AR
2011 Wong M.T.59
Comp
DVs
23
23
0
0
23
61±11
24±4
23 RP
60
2012 Akmal Y.
3)
Comp
DV
50
28
22
27
23.4±6.1
40
0
40
24
16
61.8 (26–84) 25.9 (18–44)
22 LAR/12 ISR/6 APR
40
0
40
26
14
58.9 (24–85) 28.5 (22.1–43.3)
18 LAR/9 ISR/13 APR
2012 Alimoglu61
CS
DV
7
0
7
5
2
52.9 (32–88) NR
7 APR
2012 Baek S.J.62
Comp
DV
154
0
154
105
49
59.1±12.2
23.4±3.1
3 AR/104 LAR/36 ISR/11 APR
2012 Deutsch G.B.63
Comp4) DV
18
13
5
12
6
65.2±12
25±3.8
18 RC
61
58
3
32
29
54±12.7
29.1±5.1
58 AR/2 LAR/LC
2012 Kang C.Y.64
CS
DV
6
0
6
3
3
54.5 (26–75) 24.2 (17.6–28.3)
6 APR
2012 Kang J.65
Comp
DV
165
0
165
104
61
61.2±11.4
23.1±2.8
164 LAR/Hartmann
DV
30
0
30
17
13
54 (24–78)a
27.8 (19.8–34.2)a
27 LAR/3 APR
2012 Karahasanoglu T.66 CS 67
2012 Kim J.C.
Comp
DV
100
0
100
71
29
61±9
23.8±3.1
55 LAR/45 ISR
2012 Kim Y.W.68
Comp
DV
62
0
62
41
21
56±11
24.2±2.4
50 LAR/10 ISR/APR/ Hartmann
2012 Lim D.R.69
Comp
DV
34
0
34
23
11
59.6±8.4
24.8±2.1
34 AR
2012 Lim M.S.70
CS
DV
22
0
22
12
10
58.5 (35–70) NR
22 AR
2012 Miller A.T.71
Comp
DV
17
17
0
11
6
42.8±14.8
24.7±4.3
17 ToS
2012 Park I.J.72
CS
DVs
30
0
30
16
14
58 (46–64)a
27.6 (25–32)a
5 LAR/19 ISR/6 APR
2012 Park J.S.
RCT
DV
35
0
35
14
21
62.8±10.5
24.4±2.5
35 RC
2012 Park S.Y.74
Comp
DV
40
0
40
28
12
57.3±12.1
23.9±2.4
40 ISR
2012 Shin J.Y.75
Comp
DV
30
0
30
18
12
58.1±8.6
n=22>25, n=8
