Robotic surgery: disruptive innovation or unfulfilled promise? A systematic review and meta-analysis of the first 30 years
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Author(s)
Type
Journal Article
Abstract
Background Robotic surgery has been in existence for
30 years. This study aimed to evaluate the overall perioperative
outcomes of robotic surgery compared with open
surgery (OS) and conventional minimally invasive surgery
(MIS) across various surgical procedures.
Methods MEDLINE, EMBASE, PsycINFO, and ClinicalTrials.gov
were searched from 1990 up to October 2013
with no language restriction. Relevant review articles were
hand-searched for remaining studies. Randomised controlled
trials (RCTs) and prospective comparative studies
(PROs) on perioperative outcomes, regardless of patient
age and sex, were included. Primary outcomes were blood
loss, blood transfusion rate, operative time, length of hospital
stay, and 30-day overall complication rate.
Results We identified 99 relevant articles (108 studies,
14,448 patients). For robotic versus OS, 50 studies (11 RCTs,
39 PROs) demonstrated reduction in blood loss [ratio of means
(RoM) 0.505, 95 % confidence interval (CI) 0.408–0.602],
transfusion rate [risk ratio (RR) 0.272, 95 % CI 0.165–0.449],
length of hospital stay (RoM 0.695, 0.615–0.774), and 30-day
overall complication rate (RR 0.637, 0.483–0.838) in favour of
robotic surgery. For robotic versus MIS, 58 studies (21 RCTs,
37 PROs) demonstrated reduced blood loss (RoM 0.853,
0.736–0.969) and transfusion rate (RR 0.621, 0.390–0.988) in
favour of robotic surgery but similar length of hospital stay
(RoM 0.982, 0.936–1.027) and 30-day overall complication
rate (RR 0.988, 0.822–1.188). In both comparisons, robotic
surgery prolonged operative time (OS: RoM 1.073,
1.022–1.124; MIS: RoM 1.135, 1.096–1.173). The benefits of
robotic surgery lacked robustness on RCT-sensitivity analyses.
However, many studies, including the relatively few
available RCTs, suffered from high risk of bias and inadequate
statistical power.
Conclusions Our results showed that robotic surgery
contributed positively to some perioperative outcomes but
longer operative times remained a shortcoming. Better
quality evidence is needed to guide surgical decision
making regarding the precise clinical targets of this innovation
in the next generation of its use.
30 years. This study aimed to evaluate the overall perioperative
outcomes of robotic surgery compared with open
surgery (OS) and conventional minimally invasive surgery
(MIS) across various surgical procedures.
Methods MEDLINE, EMBASE, PsycINFO, and ClinicalTrials.gov
were searched from 1990 up to October 2013
with no language restriction. Relevant review articles were
hand-searched for remaining studies. Randomised controlled
trials (RCTs) and prospective comparative studies
(PROs) on perioperative outcomes, regardless of patient
age and sex, were included. Primary outcomes were blood
loss, blood transfusion rate, operative time, length of hospital
stay, and 30-day overall complication rate.
Results We identified 99 relevant articles (108 studies,
14,448 patients). For robotic versus OS, 50 studies (11 RCTs,
39 PROs) demonstrated reduction in blood loss [ratio of means
(RoM) 0.505, 95 % confidence interval (CI) 0.408–0.602],
transfusion rate [risk ratio (RR) 0.272, 95 % CI 0.165–0.449],
length of hospital stay (RoM 0.695, 0.615–0.774), and 30-day
overall complication rate (RR 0.637, 0.483–0.838) in favour of
robotic surgery. For robotic versus MIS, 58 studies (21 RCTs,
37 PROs) demonstrated reduced blood loss (RoM 0.853,
0.736–0.969) and transfusion rate (RR 0.621, 0.390–0.988) in
favour of robotic surgery but similar length of hospital stay
(RoM 0.982, 0.936–1.027) and 30-day overall complication
rate (RR 0.988, 0.822–1.188). In both comparisons, robotic
surgery prolonged operative time (OS: RoM 1.073,
1.022–1.124; MIS: RoM 1.135, 1.096–1.173). The benefits of
robotic surgery lacked robustness on RCT-sensitivity analyses.
However, many studies, including the relatively few
available RCTs, suffered from high risk of bias and inadequate
statistical power.
Conclusions Our results showed that robotic surgery
contributed positively to some perioperative outcomes but
longer operative times remained a shortcoming. Better
quality evidence is needed to guide surgical decision
making regarding the precise clinical targets of this innovation
in the next generation of its use.
Date Issued
2016-02-19
Date Acceptance
2016-01-11
Citation
Surgical Endoscopy and Other Interventional Techniques, 2016, 30 (10), pp.4330-4352
ISSN
1432-2218
Publisher
Springer Verlag
Start Page
4330
End Page
4352
Journal / Book Title
Surgical Endoscopy and Other Interventional Techniques
Volume
30
Issue
10
Copyright Statement
© The Author(s) 2016. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
License URL
Identifier
PII: 10.1007/s00464-016-4752-x
Subjects
Conventional surgery
Perioperative outcomes
Robotic surgery
Surgery
1103 Clinical Sciences
Publication Status
Published