abstract:
Bowel injury in robotic gynecologic surgery: risk factors and management options. A systematic review
Objective
We
sought to analyze the published literature on bowel injuries in patients
undergoing gynecologic robotic surgery with the aim to determine its
incidence, predisposing factors, and treatment options.
Data Sources
Studies included in this analysis were identified by searching PubMed Central, OVID Medline, EMBASE, Cochrane, and
ClinicalTrials.gov
databases. References for all studies were also reviewed. Time frame
for data analysis spanned from November 2001 through December 2014.
Study Eligibility Criteria
All
English-language studies reporting the incidence of bowel injury or
complications during robotic gynecologic surgery were included. Studies
with data duplication, not in English, case reports, or studies that did
not explicitly define bowel injury incidence were excluded.
Study Appraisal and Synthesis Methods
The
Guidelines for Meta-Analyses and Systematic Reviews of Observational
Studies were used to complete the systematic review with the exception
of scoring study quality and a single primary reviewer.
Results
In
all, 370 full-text articles were reviewed and 144 met the inclusion
criteria. There were 84 bowel injuries recorded in 13,444 patients for
an incidence of
1 in 160 (0.62%; 95% confidence interval, 0.50–0.76%).
There were no significant differences in incidence of bowel injury by
procedure type.
The anatomic location of injury, etiology, and
management were rarely reported. Of the bowel injuries, 87% were
recognized intraoperatively and the majority (58%) managed via a
minimally invasive approach. Of 13,444 patients, 3 (0.02%) (95%
confidence interval, 0.01–0.07%)
died in the immediate postoperative
period and no deaths were a result of a bowel injury.
Conclusion
The
overall incidence of bowel injury in robotic-assisted gynecologic
surgery is 1 in 160. When the location of bowel injuries were specified,
they most commonly occurred in the colon and rectum and most were
managed via a minimally invasive approach.
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