Qualidade de vida de mulheres submetidas a histerectomia total laparoscópica convencional e roboticamente: revisão sistemática de ensaios clínicos randomizados
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Data
2021-02-26
Autores
Rodrigues, Rodrigo Corvino
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Procedimentos cirúrgicos são suscetíveis a apresentarem altos índices de complicações, como ocorrência de hospitalizações prolongadas, intervenções cirúrgicas recorrentes, dificuldades na realização das atividades diárias, distúrbios de autoimagem e da autoestima e depressão no pós operatório. A presença dessas complicações no pós-operatório pode comprometer a qualidade de vida (QV) dos pacientes, pois interfere negativamente em seu cotidiano. Na saúde da mulher, a histerectomia para doenças ginecológicas benignas realizada por cirurgia robótica tem sido associada a menores riscos de sangramentos; de infecção e escores de dor diminuídos no pós operatório, deste modo favorecendo a recuperação. Dentro dessa abordagem, a presente revisão sistemática objetivou comparar a QV e o tempo de retorno as atividades de rotina dos pacientes submetidas histerectomia total com indicações benignas realizado por cirurgia robótica (laparoscópica assistida por robô) comparado a cirurgia laparoscópica convencional. Trata-se de um estudo bibliográfico, de revisão sistemática realizada de acordo com a metodologia Cochrane. Esta revisão sistemática teve seu protocolo publicado na Prospero e em formato de artigo e sua escrita seguiu as normativas do check list PRISMA. Foram consultadas as bases de dados PUBMED, EMBASE, COCHRANE e LILACS até outubro de 2019 por meio dos descritores em saúde “Robotics”, “Hysterectomy” e “Quality of Life”. Ensaios clínicos randomizados (ECR) que reportaram por meio de instrumentos validados métricas de qualidade de vida de pacientes submetidos a histerectomia total com indicações benignas que utilizaram técnica robótica comparados com a técnica laparoscópica convencional de cirurgia foram incluídos. Revisores rastrearam independentemente artigos elegíveis; extraíram os dados e avaliaram o risco de viés por meio da abordagem Cochrane. Associações foram relatados como riscos relativos (RR) e seus intervalos de confiança de 95% (IC). A heterogeneidade foi testada com o teste de Cochrane χ2 e o grau de heterogeneidade quantificada com a estatística I2 e seu IC de 95%. O software Review Manager (RevMan) foi usado para metanálise. A qualidade da evidência foi avaliada de acordo com a Avaliação da Classificação de Recomendações, Desenvolvimento e Avaliação (GRADE). Foram incluídos dois estudos na presente revisão e as análises preliminares demonstraram que não houve diferença estatisticamente significativa para melhora da QV (RR 3.35 e 95%IC: -6.29 para 12.99) e tempo de retorno as atividades de rotina (RR -1,62 e 95% IC: -7.43 para 4.20) comparando os dois procedimentos cirúrgicos para realização de histerectomia total com indicações benignas. A qualidade da evidência foi considerada muito baixa para melhora da QV e baixa para tempo médio de retorno as atividades diárias. Esses achados demonstram que a confiança na estimativa de efeito é muito limitada, com importante grau de incerteza nos achados. Pode-se concluir que não há evidências de melhoria da QV e de redução do tempo de retorno às atividades diárias das mulheres submetidas a histerectomia total com indicações benignas que utilizaram técnica robótica comparada à técnica laparoscópica convencional cirúrgica, assim, sugere-se a elaboração de mais pesquisas para fornecimento de subsídios para avaliação de plataformas robótica em serviços de saúde.
Surgical procedures are susceptible to high complication rates, such as the occurrence of prolonged hospitalizations, recurrent surgical interventions, difficulties in carrying out daily activities, self-image and self-esteem disorders and depression in the postoperative period. The presence of these complications in the postoperative period can compromise patients' quality of life (QOL), as it interferes negatively in their daily lives. In women's health, hysterectomy for benign gynecological diseases performed by robotic surgery has been associated with lower bleeding risks; of infection and pain scores decreased in the postoperative period, thus favoring recovery. Within this approach, the present systematic review aimed to compare QOL and time to return to the routine activities of patients undergoing total hysterectomy with benign indications performed by robotic surgery (robot-assisted laparoscopy) compared to conventional laparoscopic surgery. This is a bibliographic study, systematically reviewed according to the Cochrane methodology. This systematic review had its protocol published in Prospero and in article format and its writing followed the rules of the PRISMA check list. The PUBMED, EMBASE, COCHRANE and LILACS databases were consulted until October 2019 through the health descriptors “Robotics”, “Hysterectomy” and “Quality of Life”. Randomized clinical trials (RCTs) that reported using validated quality of life metrics instruments from patients undergoing total hysterectomy with benign indications that used robotic technique compared to the conventional laparoscopic surgical technique were included. Reviewers independently screened eligible articles; extracted the data and assessed the risk of bias using the Cochrane approach. Associations were reported as relative risks (RR) and their 95% confidence intervals (CI). Heterogeneity was tested with the Cochrane χ2 test and the degree of heterogeneity was quantified with the I2 statistic and its 95% CI. The Review Manager (RevMan) software was used for metaanalysis. The quality of the evidence was assessed according to the Evaluation of the Classification of Recommendations, Development and Evaluation (GRADE). Two studies were included in this review and preliminary analyzes showed that there was no statistically significant difference for improving QOL (RR 3.35 and 95% CI: -6.29 to 12.99) and time to return to routine activities (RR -1.62 and 95% CI: -7.43 to 4.20) comparing the two surgical procedures to perform total hysterectomy with benign indications. The quality of the evidence was considered very low to improve QOL and low for the average time to return to daily activities. These findings demonstrate that confidence in the effect estimate is very limited, with an important degree of uncertainty in the findings. It can be concluded that there is no evidence of improvement in QOL and reduction in the time of return to daily activities of women undergoing total hysterectomy with benign indications that used robotic technique compared to conventional surgical laparoscopic technique, thus, it is suggested the elaboration of more research to provide subsidies for the evaluation of robotic platforms in health services.
Surgical procedures are susceptible to high complication rates, such as the occurrence of prolonged hospitalizations, recurrent surgical interventions, difficulties in carrying out daily activities, self-image and self-esteem disorders and depression in the postoperative period. The presence of these complications in the postoperative period can compromise patients' quality of life (QOL), as it interferes negatively in their daily lives. In women's health, hysterectomy for benign gynecological diseases performed by robotic surgery has been associated with lower bleeding risks; of infection and pain scores decreased in the postoperative period, thus favoring recovery. Within this approach, the present systematic review aimed to compare QOL and time to return to the routine activities of patients undergoing total hysterectomy with benign indications performed by robotic surgery (robot-assisted laparoscopy) compared to conventional laparoscopic surgery. This is a bibliographic study, systematically reviewed according to the Cochrane methodology. This systematic review had its protocol published in Prospero and in article format and its writing followed the rules of the PRISMA check list. The PUBMED, EMBASE, COCHRANE and LILACS databases were consulted until October 2019 through the health descriptors “Robotics”, “Hysterectomy” and “Quality of Life”. Randomized clinical trials (RCTs) that reported using validated quality of life metrics instruments from patients undergoing total hysterectomy with benign indications that used robotic technique compared to the conventional laparoscopic surgical technique were included. Reviewers independently screened eligible articles; extracted the data and assessed the risk of bias using the Cochrane approach. Associations were reported as relative risks (RR) and their 95% confidence intervals (CI). Heterogeneity was tested with the Cochrane χ2 test and the degree of heterogeneity was quantified with the I2 statistic and its 95% CI. The Review Manager (RevMan) software was used for metaanalysis. The quality of the evidence was assessed according to the Evaluation of the Classification of Recommendations, Development and Evaluation (GRADE). Two studies were included in this review and preliminary analyzes showed that there was no statistically significant difference for improving QOL (RR 3.35 and 95% CI: -6.29 to 12.99) and time to return to routine activities (RR -1.62 and 95% CI: -7.43 to 4.20) comparing the two surgical procedures to perform total hysterectomy with benign indications. The quality of the evidence was considered very low to improve QOL and low for the average time to return to daily activities. These findings demonstrate that confidence in the effect estimate is very limited, with an important degree of uncertainty in the findings. It can be concluded that there is no evidence of improvement in QOL and reduction in the time of return to daily activities of women undergoing total hysterectomy with benign indications that used robotic technique compared to conventional surgical laparoscopic technique, thus, it is suggested the elaboration of more research to provide subsidies for the evaluation of robotic platforms in health services.
Descrição
Palavras-chave
Robótico, Histerectomia, Laparoscopia, Qualidade de vida, Revisão sistemática, Robotics, Hysterectomy, Laparoscopy, Quality of life, Systematic review