Comparison of Clinical Outcomes of Robotic Natural Orifice Specimen Extraction Surgery and Transabdominal Wall Specimen Retrieval in Colorectal Surgery: A Systematic Review and Meta-analysis

This systematic review and meta-analysis compared the outcomes of natural orifice specimen extraction with those of conventional abdominal incision specimen extraction in robot-assisted colorectal surgery. Based on PubMed, Embase, and Cochrane Library databases, 868 participants across seven studies were pooled. Data on short-term clinical outcomes and long-term oncological outcomes were evaluated. Random-effect models were used for analysis. The meta-analysis showed that natural orifice specimen extraction had fewer total postoperative (odds ratio 0.65) and wound-related (odds ratio 0.17) complications and lower postoperative day 1 white blood cell (weighted mean difference −1.12) and postoperative day 1 and 3 C-reactive protein (weighted mean difference −8.2 and −10.7, respectively) levels. During postoperative recovery, natural orifice specimen extraction led to less pain, fewer analgesics, and faster flatus passage. The long-term oncological outcomes revealed no significant differences. Natural orifice specimen extraction in robot-assisted colorectal surgery provides improved recovery and similar oncological safety as abdominal incision specimen extraction.