Robotic versus conventional neck dissection: A systematic review and meta‐analysis
Daniel C. Sukato MD Daniel P. Ballard MD Jason M. Abramowitz MD Richard M. Rosenfeld MD, MPH Stefan Mlot MD
First published: 16 October 2018 https://doi.org/10.1002/lary.27533
The authors have no funding, financial relationships, or conflicts of interest to disclose.
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Abstract
Objective
The aim of this systematic review is to compare the perioperative outcomes of robotic versus conventional neck dissection in patients with head and neck malignancy.
Methods
An electronic search of PubMed, Web of Science, and EMBASE databases was conducted. We included studies with direct comparisons of robotic and open neck dissections and performed dual, independent data extraction for primary outcomes of nodal yield, recurrence rate, subjective cosmetic assessment, operative time, length of stay, and rates of perioperative complications. Data were pooled using random effects meta‐analysis to determine the standardized mean difference (SMD), absolute risk difference (RD), and 95% confidence intervals (CI).
Results
Eleven comparative studies comprising 225 robotic and 430 open neck dissections met the final selection criteria. All studies had low to moderate risk of bias. Robotic surgery improved cosmesis (SMD 1.15, 95% CI 0.73 to 1.56) but also increased operative time (SMD 1.94, 95% CI 1.25 to 2.63). Total nodal yield, pathological nodal yield, recurrence rate, rates of perioperative complications, and length of stay were not significantly different between the two groups, and the 95% CIs suggested that false negative results were unlikely. The results remained consistent after stratification by pathology and robotic technique.
Conclusion
Although robotic neck dissection may offer similar perioperative outcomes compared to conventional neck dissection, it requires significantly more operative time. Whereas cosmesis was found to be superior among the robotic cohort, this must be viewed cautiously given the nonvalidated measurement tool that was used and the inherent reporting bias associated with it.
Laryngoscope, 129:1587–1596, 2019
Daniel C. Sukato MD Daniel P. Ballard MD Jason M. Abramowitz MD Richard M. Rosenfeld MD, MPH Stefan Mlot MD
First published: 16 October 2018 https://doi.org/10.1002/lary.27533
The authors have no funding, financial relationships, or conflicts of interest to disclose.
Read the full text
ePDFPDFTOOLS SHARE
Abstract
Objective
The aim of this systematic review is to compare the perioperative outcomes of robotic versus conventional neck dissection in patients with head and neck malignancy.
Methods
An electronic search of PubMed, Web of Science, and EMBASE databases was conducted. We included studies with direct comparisons of robotic and open neck dissections and performed dual, independent data extraction for primary outcomes of nodal yield, recurrence rate, subjective cosmetic assessment, operative time, length of stay, and rates of perioperative complications. Data were pooled using random effects meta‐analysis to determine the standardized mean difference (SMD), absolute risk difference (RD), and 95% confidence intervals (CI).
Results
Eleven comparative studies comprising 225 robotic and 430 open neck dissections met the final selection criteria. All studies had low to moderate risk of bias. Robotic surgery improved cosmesis (SMD 1.15, 95% CI 0.73 to 1.56) but also increased operative time (SMD 1.94, 95% CI 1.25 to 2.63). Total nodal yield, pathological nodal yield, recurrence rate, rates of perioperative complications, and length of stay were not significantly different between the two groups, and the 95% CIs suggested that false negative results were unlikely. The results remained consistent after stratification by pathology and robotic technique.
Conclusion
Although robotic neck dissection may offer similar perioperative outcomes compared to conventional neck dissection, it requires significantly more operative time. Whereas cosmesis was found to be superior among the robotic cohort, this must be viewed cautiously given the nonvalidated measurement tool that was used and the inherent reporting bias associated with it.
Laryngoscope, 129:1587–1596, 2019
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