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Intraoperative image-guidance during robotic surgery: is there clinical evidence of enhanced patient outcomes?

  • Review Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Background

To date, the benefit of image guidance during robot-assisted surgery (IGS) is an object of debate. The current study aims to address the quality of the contemporary body of literature concerning IGS in robotic surgery throughout different surgical specialties.

Methods

A systematic review of all English-language articles on IGS, from January 2013 to March 2023, was conducted using PubMed, Cochrane library’s Central, EMBASE, MEDLINE, and Scopus databases. Comparative studies that tested performance of IGS vs control were included for the quantitative synthesis, which addressed outcomes analyzed in at least three studies: operative time, length of stay, blood loss, surgical margins, complications, number of nodal retrievals, metastatic nodes, ischemia time, and renal function loss. Bias-corrected ratio of means (ROM) and bias-corrected odds ratio (OR) compared continuous and dichotomous variables, respectively. Subgroup analyses according to guidance type (i.e., 3D virtual reality vs ultrasound vs near-infrared fluoresce) were performed.

Results

Twenty-nine studies, based on 11 surgical procedures of three specialties (general surgery, gynecology, urology), were included in the quantitative synthesis. IGS was associated with 12% reduction in length of stay (ROM 0.88; p = 0.03) and 13% reduction in blood loss (ROM 0.87; p = 0.03) but did not affect operative time (ROM 1.00; p = 0.9), or complications (OR 0.93; p = 0.4). IGS was associated with an estimated 44% increase in mean number of removed nodes (ROM 1.44; p < 0.001), and a significantly higher rate of metastatic nodal disease (OR 1.82; p < 0.001), as well as a significantly lower rate of positive surgical margins (OR 0.62; p < 0.001). In nephron sparing surgery, IGS significantly decreased renal function loss (ROM 0.37; p = 0.002).

Conclusions

Robot-assisted surgery benefits from image guidance, especially in terms of pathologic outcomes, namely higher detection of metastatic nodes and lower surgical margins. Moreover, IGS enhances renal function preservation and lowers surgical blood loss.

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Data availability

The code for the analyses will be made available upon request.

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Authors and Affiliations

  1. Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Stefano Tappero, Francesco Chierigo & Paolo Dell’Oglio

  2. Department of Urology, European Institute of Oncology (IEO), University of Milan, Milan, Italy

    Giuseppe Fallara & Mattia Luca Piccinelli

  3. Department of Urology, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy

    Francesco Chierigo

  4. Department of Urology, IRCCS Ospedale Policlinico San Martino, University of Genova, Genoa, Italy

    Francesco Chierigo & Francesca Ambrosini

  5. Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genoa, Italy

    Francesco Chierigo, Francesca Ambrosini & Raquel Diaz

  6. Department of General Surgery, Luigi Sacco University Hospital, Milan, Italy

    Andrea Micalef

  7. Università Degli Studi Di Milano, Milan, Italy

    Andrea Micalef

  8. Department of Orthopaedics, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy

    Andrea Dorotei

  9. Department of Biomedical Sciences, Humanitas University, Milan, Italy

    Andrea Dorotei

  10. Neurosurgery and Gamma Knife Radiosurgery Unit, IRCCS Ospedale San Raffaele, Milan, Italy

    Edoardo Pompeo & Luigi Albano

  11. Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Alessia Limena

  12. Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy

    Alessia Limena

  13. Department of Urology, Northampton General Hospital, Northampton, UK

    Carlo Andrea Bravi

  14. Department of Urology, Royal Marsden Foundation Trust, London, UK

    Carlo Andrea Bravi

  15. Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Mattia Longoni, Francesco Barletta & Elio Mazzone

  16. Vita-Salute San Raffaele University, Milan, Italy

    Mattia Longoni, Francesco Barletta & Elio Mazzone

  17. Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy

    Luigi Albano

  18. Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands

    Paolo Dell’Oglio

  19. Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands

    Paolo Dell’Oglio

Authors
  1. Stefano Tappero
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  2. Giuseppe Fallara
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  3. Francesco Chierigo
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  4. Andrea Micalef
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  5. Francesca Ambrosini
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  6. Raquel Diaz
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  7. Andrea Dorotei
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  8. Edoardo Pompeo
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  9. Alessia Limena
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  10. Carlo Andrea Bravi
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  11. Mattia Longoni
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  12. Mattia Luca Piccinelli
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  13. Francesco Barletta
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  14. Luigi Albano
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  15. Elio Mazzone
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  16. Paolo Dell’Oglio
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Contributions

Conception and design: PDO, EM, ST.

Literature search: ST, FC, AM, FA, RD, AD, EP, AL, ML, MLP, FB, LA.

Title and abstract screening: ST, FC, AM, FA, RD, AD, EP, AL, ML, MLP, FB.

Full text screening: ST, FC, AM, FA, RD, AD, EP, AL, ML, MLP, FB.

Data extraction: ST, FC, EP, LA.

Analysis/interpretation of data: PDO, EM, CAB, GF.

Statistical analysis: PDO, EM, GF.

Drafting the manuscript: ST, GF, FC, EM, PDO.

Critically revising the manuscript: All authors discussed the results and implications and commented on the manuscript at all stages.

Final approval of the manuscript: All authors.

Corresponding author

Correspondence to Paolo Dell’Oglio.

Ethics declarations

Ethics consent

Study-specific Institutional Review Board ethics approval was not required.

Patient consent statement, permission to reproduce material from other sources and clinical trial registration

Not applicable.

Conflict of interest

The authors declare no competing interests.

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ST and GF share first authorship.

EM and PDO share last authorship.

Supplementary Information

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Tappero, S., Fallara, G., Chierigo, F. et al. Intraoperative image-guidance during robotic surgery: is there clinical evidence of enhanced patient outcomes?. Eur J Nucl Med Mol Imaging (2024). https://doi.org/10.1007/s00259-024-06706-w

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  • DOI: https://doi.org/10.1007/s00259-024-06706-w

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