Laparoscopic Surgery Systematic Review

1Running head: MEDICINE AND HEALTH
Medicine and Health
Name of student:
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Table of Contents
Abstract......................................................................................................................................4
Introduction................................................................................................................................5
Aims............................................................................................................................................6
Objective....................................................................................................................................6
Research question......................................................................................................................7
Background literature review....................................................................................................7
Methodology.............................................................................................................................12
Research protocol....................................................................................................................19
PICOS framework................................................................................................................19
Materials and methods.........................................................................................................20
Search strategy.....................................................................................................................20
Key terms.............................................................................................................................20
Study selection.....................................................................................................................22
Quality assessment...............................................................................................................22
Appraisal of rigor.................................................................................................................23
Ethical appraisal..................................................................................................................23
Data extraction.....................................................................................................................24
Data analysis........................................................................................................................26
Limitations................................................................................................................................26
Dissemination and sharing of the research findings................................................................28

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References................................................................................................................................29
Appendices...............................................................................................................................37

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Is the surgical outcome and costs of robotic-assisted surgery more effective than
Laparoscopic surgery for colorectal cancer surgery?
Abstract
Colorectal cancer refers to the presence of a tumor or lump in the colon and the rectum. It is
the second most prevalent cancer among humans, after lung cancer. Although, traditional
laparoscopic surgical techniques have been used since decades to treat colorectal cancer, this
surgical procedure has certain limitations. One major limitation related to the use of
laparoscopy is associated with the poor ergonomic postioninig of the surgeons who
participate in the surgery. Other limitations are related to the restricited movements of the
surgical instruments and 2-dimensional imaging of the body organs. To overcome thrse
limitations, recently surgeons have started promoting the use of robotic assisted surgery for
treatment of colorectal cancer. This technique is an emerging one and has several technical
advantages over the conventional laparoscopic procedure. Some of the advantages that
robotic assisted surgery has includes, presence of 3 dimensional imaging, improved
visualisation, tremor filter and well articulated instruments. The procedure involves the
sitting of a surgeon at the robotic console. This is followed by placing the fingers of the
surgeon on the robotic control system. The robotic system thereby translates the movement of
the surgeons' fingers and wrists and operatres the tumor. Thus, it allows better dexterity than
the conventional laparoscopic instruments. Therefore, this systematic review aims to
critically evaluate articles that compare the effects of robotic surgery with those of
laparoscopy, on the benefits that patients may gain. Hence, the research proposal will search
for relevant articles and determine the immediate effects of robotic assisted surgery on
discomfort and pain, length of hospitalisation, patient recovey time and amount of blood loss.
keywords- laparoscopy, robotic assisted surgery, colorectal cancer, benefits

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Introduction
Among the most prevalent forms of cancer is colorectal cancer, which again might be
of different forms such as adenocarcinoma, carcinoid tumors and lymphoma. The incidence
of colorectal cancer in the UK is noteworthy, as well as the mortality rate, drawing the
attention of health care professionals to come up with suitable treatment strategies (Siegel et
al. 2017). Colorectal cancer is the fourth most common form of cancer in the country. In both
females and males, it is the third most common form of cancer. There were 41,300 new cases
of colorectal cancer being reported in the year 2014. This implied diagnosis o around 110
cases each day. Around 15,903 deaths occurred in the year 2014 due to this form of cancer.
Colorectal cancer is the second most common cause of cancer in the country and accounts for
10% of all cancer deaths (Stewart and Wild 2017).
Surgery has been denoted as the primary treatment option for a patient suffering from
early-stage colorectal cancer. The form of surgery that is to be undertaken is dependent on the
cancer stage and the primary goal of the surgery. There are certain side effects and risks
associated with colorectal surgery, and these are dependent on diverse factors such as
patient’s general health, the extent of the operation and healthcare environment
(Karayiannakis 2016). According to Niitsu et al. (2016), laparoscopic colorectal cancer
surgery is the most widely used form of treatment and healthcare data points out its
advantageous in comparison to open surgery approach. The benefits that this method has to
include the shorter duration of hospital stay, negligible blood loss due to operation ad less
pain suffered by patients. Though initial concerns regarding the adequacy of the extent of
resection and port-site recurrence had been dismissed, different groups of scholars have
pointed out that laparoscopic surgery is not universally accepted. As opined by Yasui et al.
(2017) laparoscopic surgery is much challenging, and there is a number of concerns

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remaining integrated to this process. These are confined space in the pelvis, maintenance of
resection margin and inability to convert to open surgery.
Research is constantly going on in the area of surgery of colorectal cancer surgery and
scientists are attempting to find advanced and novice methods by which the surgical
procedure can be effective and safe as well (Gamagami, Kozak and Kakarla 2017). Robotic
surgery has gained attention in the recent past as a new and advanced method of treating
colorectal cancer. Such form of surgery can be performed with the hep of different techniques
which might include laparoscopic surgery. Research has highlighted that there are different
advantages of using this mode of surgery such as steadiness and 3D surgical view. However,
cost effectiveness is a crucial barrier to implementing robotic surgery method on a larger
scale (Guend et al. 2017).
Against this background there is a need for understanding the relative benefits and
challenges of using robotic-assisted surgery and Laparoscopic surgery for colorectal cancer.
A rigorous comparison and analysis of the two methods are entailed at present. Whether the
surgical outcome and costs of robotic-assisted surgery are better than Laparoscopic surgery
for colorectal cancer surgery would be a praiseworthy topic for research.
Aims
The primary aim of the proposed systematic review is to undertake an evaluation of
costs and surgical outcomes of robotic-assissted surgery in comparison to laproscopic surgery
to understand which is better for colorectal cancer.
Objective
The key objectives of the systematic review proposal are as follows-

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 To understand the cost effectiveness of robotic-assissted surgery in comparison to
laproscopic surgery for colorectal cancer
 To evaluate the surgical outcomes of robotic-assissted surgery in comparison to
laproscopic surgery for colorectal cancer
 To highlight among robotic-assissted surgery and laproscopic surgery can be applied
at large scale in the near future
Research question
The research question that would be addressed in the proposed systematic reviewis as
follows-
Is the surgical outcome and cost of robotic-assisted surgery more effective than
Laparoscopic surgery for colorectal cancer?
Background literature review
Multiple trials have been conducted in the past 5 years in order to prove the cost
effectiveness and safety of robotic-assisted surgery when compared to laproscopic surgical
procedures for colorectal cancer. 9 studies have been compared in this literature review in
order to illustrate the cost effectiveness of robotic surgery and its possible role in improving
clinical outcomes.
Throughout the literature, while making a comparsion between the two surgical
approaches, typical and consistent arguments have been presented by the author in order to
prove which method is more cost effective and feasible regarding colorectal cancer surgery in
recent medical practice. The reviews published till date are of moderate to high quality in
terms of the scientific methodology that has been followed and the hierarchy of evidence
presented in the literature. Nevertheless, the authors failed to provide an universal statement

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or consensus regarding the implementation of robotic-assisted surgery as the best surgical
practice.
Sawada et al. (2015) used the method of propensity score matching and conducted a
matched case-control study in order to evaluate the short-term benefits of robotic-assisted
surgery in case of colorectal cancer. The scores were compared with those of the
conventional laparoscopic surgerical procedures. The study recruited 10 patients with left-
sided colon and rectal cancer, who underwent robotic surgery, and compared them to the
outcomes observed among 20 patients receiving conventional laparoscopic surgery, after
propensity score matching. The results did not show any significant difference in
clinicopathologic outcomes between the two groups. However, the robotic-assisted surgery
took longer operation time than the conventional surgery method. Thus, the study indicated
that apart from operative time no changrs were observed among the two methods and robotic
surgery is a promising tool that can be used for treating colorectal cancer patients.
Taggarshe et al. (2014) argued that robotic surgery is a safe, suitable and feasible
technique for colorectal cancer. The study conducted an extensive literature search and
extracted data related to the operation details, clinical outcomes, blood loss and intraoperative
complications. The review identified that the mean operative time for robotic colonic surgery
was 224 minutes. Furthermore, the mean estimated blood loss was found to be 47.67 mls, and
the post-operative mean morbidity rate was 23%. Thus,the study concluded that although
robotic-assisted surgety was associated with sexual and urinary dysfunction and longer
operation time, it was related to lower blood loss, lower conversions and better visualisation.
Therefore, it was considered to be a feasible technique.
This study was supported by a review that gave a general overview regarding the
potential advantages of robotic surgery over laproscopic surgical approach and also provided