gms | German Medical Science

Background/research question: In surgical advancements, robot-assisted surgery (RAS) holds several promises like shorter hospital stays, reduced complications, and improved technical capabilities over standard care. Despite extensive evidence, the actual patient benefits of RAS remain unclear. Thus, our systematic review aimed to assess the effectiveness and safety of RAS in visceral and thoracic surgery compared to laparoscopic or open surgery.

Methods: We performed a systematic literature search in two databases (Medline via Ovid and The Cochrane Library) in April 2023. The search was restricted to 14 predefined thoracic and visceral procedures and randomized controlled trials (RCTs). Synthesis of data on critical outcomes followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) scheme, and the risk of bias was evaluated using the Cochrane Collaboration's Tool Version 1. All procedures were performed by two independent researchers.

Results: For five out of 14 procedures, no evidence could be identified. A total of 20 RCTs and five follow-up publications met the inclusion criteria. Overall, most studies had either not reported or measured patient-relevant endpoints. The majority of outcomes showed comparable results between study groups. However, RAS demonstrated potential advantages in specific endpoints (e.g., blood loss), yet these findings relied on a limited number of low-quality studies. Statistically significant RAS benefits were also noted in some outcomes for certain indications—recurrence, quality of life, transfusions, and hospitalisation. Safety outcomes were improved for patients undergoing robot-assisted gastrectomy, as well as rectal and liver resection. Regarding operation time, results were contradicting; shorter surgeries were limited to robot-assisted liver resections and fundoplications, while five indications showed prolonged surgeries.

Conclusion: In summary, conclusive assertions on RAS superiority are impeded by inconsistent and insufficient evidence across various outcomes and procedures. While RAS may offer potential advantages in some surgical areas, healthcare decisions should additionally consider the limited evidence quality, financial implications, and environmental factors.

Competing interests: Dr. scient. med. Grössmann-Waniek, Riegelnegg, MA, Dr. Gassner, and Priv. Doz. Dr. phil. Wild have no conflicts of interest or financial ties to disclose.