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Purpose: Scarce research has reported the comparison between robotic and laparoscopic surgery in mid-low rectal cancer. Therefore, this meta-analysis is aimed to compare the safety and efficacy of the two surgical approaches., Methods: A comprehensive search of the databases (PubMed, EMBASE, Cochrane, and Web of Science) was performed for studies comparing robotic and laparoscopic surgery. The outcomes of interest acquired from eight articles included three aspects: intraoperative conditions, postoperative status of patients, and complications. All data (robotic = 1350 patients, laparoscopic = 1330 patients) enrolled were analyzed using Rev Man 5.4., Results: Compared to the laparoscopic group, the robotic group indicated a noticeable superiority in estimated blood loss (P < 0.0001), number of lymph nodes dissected (P = 0.004), time to first flatus (P = 0.001), time to first fluid diet (P = 0.001), hospital stay (P < 0.0001), conversion (P = 0.009), and urinary retention (P = 0.0006), but devoted much more operation time (P = 0.0004)., Conclusion: Robotic surgery was associated with superiority over laparoscopic surgery in increasing surgical safety, accelerating postoperative recovery, and reducing complications, which suggested that robotic surgery could be a safe and effective method for treating mid-low rectal cancer., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Scarce research has been performed to assess the safety and efficacy of anastomosis technique on robotic-assisted sigmoidectomy. This study was designed to evaluate the difference between intracorporeal and extracorporeal techniques during robotic-assisted sigmoidectomy. Clinical data of 193 cases who received robotic-assisted sigmoidectomy were retrospectively collected and analyzed. Only 116 cases were available for analysis (intracorporeal group = 58 and extracorporeal group = 58) after propensity score matching. Independent sample t test was conducted to evaluate the continuous variables. Moreover, the statistical significance of categorical variables was tested using Chi-square or Fisher's exact tests. Statistical analysis showed that the intracorporeal group demonstrated greater superiorities in pain scale on the first and second postoperative day (P < 0.05), time of catheter indwelling (P = 0.009), and length of hospital stay (P = 0.019). Additionally, the intracorporeal technique contributed to fewer complications including urinary retention (P = 0.027) and hernia (P = 0.037) than the extracorporeal group. Our analysis revealed that intracorporeal technique was safe and feasible due to the shorter time of catheter indwelling and length of hospital stay and fewer post-operation complications., (© 2023. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Background/aims: Recently, single-incision laparoscopic colectomy (SILC) for colorectal malignancy is rapidly becoming the central issue for explorers of minimally invasive surgery worldwide. The aim of this systematic review was to establish the safety and efficacy of SILC for colorectal malignancy when implemented by experienced surgeons., Methodology: PubMed, WHO international trial register and Embase were searched for publications concerning SILC and MLC from 2000 to 2013, with the last search on September 10, 2013. Only pure single-incision laparoscopic colonic surgery for malignant disease was included. Primary outcomes were the early postoperative complication profiles of SILC. Secondary outcomes were duration of operation time, blood loss, lymph node yields, conversion rate, distal margin of the resected tumor, and duration of hospital stay., Results: Eight studies involving 547 patients met the inclusion criteria. Compared with multiport laparoscopic colectomy (MLC), SILC has less postoperative complication and bleeding. The conversion, the median lymph node retrieval, proximal margin of the resected tumor and distal margin of the resected tumor for malignant disease achieved with SILC was acceptable. There was no significant reduction in length of hospital stay with SILC., Conclusion: SILC is a technically reliable and realistic approach with short-term results similar to those obtained with the MLC procedure.

Aim: To compare the safety of fast-track rehabilitation protocols (FT) and conventional care strategies (CC), or FT and laparoscopic surgery (LFT) and FT and open surgery (OFT) after gastrointestinal surgery., Methods: We searched MEDLINE, WHO International Trial Register, Embase and The Cochrane Central Register of Controlled Trials up to 2014 for randomized controlled trials (RCTs) comparing FT and CC or comparing LFT and OFT, with 10 or more randomized participants and about 30 d follow-up. Two reviewers independently extracted data on complications, anastomotic leak, obstruction, wound infection, re-admission between FT and CC or LFT and OFT after gastrointestinal surgery., Results: Twenty-four RCTs of FT vs CC or LFT vs OFT were included. Compared with CC, FT reduced overall complications and wound infection. However, anastomotic leak, obstruction and re-admission were not significantly reduced. The pooled risk ratio (RR) of 0.69 (95%CI: 0.60-0.78; P < 0.001), pooled RR of 0.71 (95%CI: 0.57-0.88; P < 0.001), pooled RR of 0.93 (95%CI: 0.68-1.25; P > 0.05), a pooled RR of 0.87 (95%CI: 0.67-1.15; P > 0.05) and pooled RR of 0.94 (95%CI: 0.73-1.22; P > 0.05) respectively. Compared with OFT, LFT reduced complications, with a pooled RR of 0.66 (95%CI: 0.54-0.81; P < 0.001)., Conclusion: FTs are safe after gastrointestinal surgery. Additional large, prospective RCTs should be conducted to establish further the safety of this approach.

Background/aims: Bariatric surgery has become the best option for the treatment for morbid obesity. It is not only a weight-reducing surgery but also a metabolic surgery. This study examined the short-term results undergoing LRYGB and LSG of bariatric surgery., Methodology: Studies and relevant literatures regarding the formation of LRYGB vs. LSG for morbid obesity or diabetes were searched through PubMed and Embase. The resolution of diabetes mellitus, resolution of hypertension and excess weight loss (EWL) in 12 months by LRYGB or LSG were pooled and compared using a meta-analysis. The odd ratios and mean differences were calculated with 95% confidence intervals to evaluate the influence of LRYGB., Results: Sixteen recent studies including 2758 patients in total were included in this meta-analysis. These studies demonstrated that compared with LSG, LRYGB had the better effect in resolving diabetes mellitus and excess weight loss at 12 months, had a similar effect in resolving hypertension (pooled OR of 2.46 (95% CI: 1.48-4.09, p<0.00001), pooled OR of 0.81 (95% CI: 0.57-1.16, p>0.005), pooled mean difference of 8.27 (95% CI: 6.89-9.66, p<0.00001), respectively)., Conclusions: In bariatric surgery, LRYGB is a more effective and reliable treatment for morbid obesity and for surgical treatment of poorly controlled T2DM. More large, prospective, controlled, randomized trials should be conducted to further compare the efficacy and safety of this approach.

Objective: To investigate the safety and feasibility of laparoscopic D2 gastrectomy for advanced gastric cancer., Methods: The clinical data of 210 cases of laparoscopic gastrectomy and 180 cases of open gastrectomy for radical (D2) gastrectomy from May 2007 to Dec 2010 were analyzed retrospectively., Results: A total of 206 cases underwent laparoscopic-assisted surgery with 4 conversions. Compared to the open group, the laparoscopic group was associated with less bleeding [(208±38) ml vs. (300±52) ml, P<0.05], quicker postoperative recovery of bowel function [(2.9±0.7) d vs. (3.9±1.8) d, P<0.05], shorter postoperative length of hospital stay[(12.8±6.2) d vs. (15.6±6.8) d, P<0.05], longer operative time [(258±42) min vs. (193±30) min, P<0.05]. The number of lymph node harvested was 20.5±1.9 in the laparoscopic group and 25.8±1.5 in the open group, and the postoperative complication rate was 8.1% (17/201) vs. 8.5% (15/180), and differences were not statistically significant (both P>0.05). The recurrence rate was 2.9% (6/210) and 2.8% (5/180), and the 3-year overall survival rate was 35.6% and 37.8%, the differences were not statistically significant (both P>0.05)., Conclusions: Laparoscopic radical gastrectomy for gastric cancer is safe and effective, which can reach the same range of lymph node dissection as open gastric cancer surgery and similar survival rate.

Background/aims: Single-incision laparoscopic colectomy (SILC) is rapidly becoming the focal point of attraction for early adopters of minimally invasive surgery worldwide. The aim of this study was to compare SILC with multiport laparoscopic colectomy (MLC) when implemented by experienced laparoscopic surgeons., Methodology: Studies and relevant literature regarding the formation of SILC vs. MLC were searched though PubMed and Embase. The volume of bleeding, the rates of conversion /adding trocars and morbidities by using single-incision laparoscopic surgery or multiport laparoscopic surgery were pooled and compared using a meta-analysis. The risk ratios and mean different were calculated with 95% confidence intervals to evaluate the influence of SILC., Results: Eleven recent studies including 800 patients in total were included in this meta-analysis. These studies demonstrated that compared to MLC, SILC has the advantage of less bleeding, higher rates of conversion and has similar morbidities. Pooled mean difference of -29.9 (95% CI: -47.05-(-12.74); p<0.001), a pooled RR of 2.04 (95% CI: 1.24-3.36; p<0.01) and a pooled RR of 0.94 (0.72-1.21; p>0.05), respectively., Conclusions: SILC is a technically realistic and reliable approach with short-term results similar to those obtained with the MLC procedure. More large, prospective, randomized, controlled trials should be conducted to further compare the safety and efficacy of this approach.