Implementation of robotic and laparoscopic hepatopancreatobiliary surgery in low- and middle-income settings: a systematic review and meta-analysis
Falola, Adebayo Ezebialu, Chioma Okeke, Sophia Fadairo, Rhoda T Dada, Oluwasina S Adeyeye, Ademola
Falola, Adebayo
Ezebialu, Chioma
Okeke, Sophia
Fadairo, Rhoda T
Dada, Oluwasina S
Adeyeye, Ademola
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Publication date
2025-03-14
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Abstract
Background: Despite numerous barriers, the application of minimally invasive surgery (MIS) for hepatopancreatobiliary (HPB) conditions has been increasing globally. This study aims to review the current status of HPB MIS in LMICs.
Methods: Relevant databases were searched, identifying 3452 publications, 38 of which met the inclusion criteria. Meta-analysis of outcomes was carried out using "R" statistical software.
Results: This study reviewed reports of application of MIS for HPB conditions in LMICs, analyzing a total of 3272 procedures. India (66.87 %) and Egypt (20.11 %) contributed majorly to the procedures reviewed. Others were from Indonesia (8.68 %), Colombia (3.06 %), Pakistan (0.67 %), Sri Lanka (0.34 %), Trinidad and Tobago (0.18 %), and Nigeria (0.09 %). India was the only LMIC with robotic HPB MIS. The majority of the procedures were biliary (74.88 %). Basic procedures accounted for 55.63 %, while 44.37 % were advanced. The overall conversion rate and prevalence of morbidity were 8 % [95 % CI: 5; 13], and 15 % [95 % CI: 9; 22], respectively. Robotics was associated with higher conversion (14 % vs 6 %, p < 0.01) but lower morbidity (10 % vs 16 %, p = 0.91), compared to laparoscopic surgery. There were 5 cases of mortality from laparoscopy.
Conclusion: The outcomes in this systematic review, compared to findings in other settings indicate successful implementation of HPB MIS in LMICs.
Citation
Falola A, Ezebialu C, Okeke S, Fadairo RT, Dada OS, Adeyeye A. Implementation of robotic and laparoscopic hepatopancreatobiliary surgery in low- and middle-income settings: a systematic review and meta-analysis. HPB (Oxford). 2025 Jul;27(7):869-883. doi: 10.1016/j.hpb.2025.03.006. Epub 2025 Mar 14.
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