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The evidence behind robot-assisted abdominopelvic surgery: a meta-analysis of randomized controlled trials

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Abstract

Background

Despite recent advancements, the advantage of robotic surgery over other traditional modalities still harbors academic inquiries. We seek to take a recently published high-profile narrative systematic review regarding robotic surgery and add meta-analytic tools to identify further benefits of robotic surgery.

Methods

Data from the published systematic review were extracted and meta-analysis were performed. A fixed-effect model was used when heterogeneity was not significant (Chi2 p ≥ 0.05, I2 ≤ 50%) and a random-effects model was used when heterogeneity was significant (Chi2 p < 0.05, I2 > 50%). Forest plots were generated using RevMan 5.3 software.

Results

Robotic surgery had comparable overall complications compared to laparoscopic surgery (p = 0.85), which was significantly lower compared to open surgery (odds ratio 0.68, p = 0.005). Compared to laparoscopic surgery, robotic surgery had fewer open conversions (risk difference − 0.0144, p = 0.03), shorter length of stay (mean difference − 0.23 days, p = 0.01), but longer operative time (mean difference 27.98 min, p < 0.00001). Compared to open surgery, robotic surgery had less estimated blood loss (mean difference − 286.8 mL, p = 0.0003) and shorter length of stay (mean difference − 1.69 days, p = 0.001) with longer operative time (mean difference 44.05 min, p = 0.03). For experienced robotic surgeons, there were less overall intraoperative complications (risk difference − 0.02, p = 0.02) and open conversions (risk difference − 0.03, p = 0.04), with equivalent operative duration (mean difference 23.32 min, p = 0.1) compared to more traditional modalities.

Conclusion

Our study suggests that compared to laparoscopy, robotic surgery may improve hospital length of stay and open conversion rates, with added benefits in experienced robotic surgeons showing lower overall intraoperative complications and comparable operative times.

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Funding

No funding was received for the body of this research work.

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Authors and Affiliations

  1. Department of Surgery, University of South Florida, Tampa, FL, 33620, USA

    Jae Hwan Choi, Abdul-Rahman Diab, Katherine Tsay, Davis Kuruvilla, Samer Ganam, Adham Saad, Salvatore Docimo Jr., Joseph A. Sujka & Christopher G. DuCoin

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  1. Jae Hwan Choi
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  2. Abdul-Rahman Diab
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  3. Katherine Tsay
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Corresponding author

Correspondence to Christopher G. DuCoin.

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Disclosures

Dr. Adham Saad is on the list of guest speakers and lab supporters for Integra Lifesciences and serves as an expert witness for Huff, Powell, & Bailey. Dr. Salvatore Docimo Jr is on the list of guest speakers for BD, Medtronic, and Boston Scientific. Dr. Joseph A. Sujka serves as a consultant for Enterra Medical. Dr. Christopher G. Ducoin serves as a consultant for Intuitive Surgical, Medtronic Surgical, and Johnson & Johnson. Drs. Jae Hwan Choi, Abdul-Rahman Diab, Samer Ganam and Ms. Katherine Tsay and Mr. Davis Kuruvilla have no conflicts of interest or financial ties to disclose.

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The authors of this publication consult for Intuitive Surgical, Inc., and conduct research in areas of interests similar to the business interests of Intuitive Surgical. The terms of this arrangement have been reviewed and approved by the University of South Florida in accordance with its policy on objectivity in research.

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Choi, J.H., Diab, AR., Tsay, K. et al. The evidence behind robot-assisted abdominopelvic surgery: a meta-analysis of randomized controlled trials. Surg Endosc (2024). https://doi.org/10.1007/s00464-024-10773-3

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