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Published online by Cambridge University Press: 23 December 2022
Robot-assisted surgery (RAS) is being adopted rapidly internationally across a wide range of surgical procedures. Although a great deal of evidence of the clinical effectiveness of RAS has been generated, it is possible that the evidence base is not complete or persuasive in some areas where adoption is being considered. This review seeks to summarize systematic reviews (SRs) undertaken to date to illustrate the weight of evidence across specialties. We then take an in depth look at the quality of evidence across several indications where the adoption of RAS is currently underway.
A comprehensive literature search was conducted using Ovid Medline, Embase, and Cochrane Central Register of Systematic Reviews from January 2017 to April 2021 for SRs describing clinical effectiveness outcomes. The body of evidence was mapped across all specialties. For a selected number of indications currently under consideration in Scotland, results were comparatively summarized, and the quality of the reviews was evaluated with the AMSTAR-2 tool.
A total of 451 SRs were found. Most were in urology (n = 130) where RAS is well established, followed by colorectal (n = 63), hepatology (n = 58), and gynecology (n = 41). From within these latter three specialties, we selected six indications in which RAS is currently being considered for adoption in Scotland for in depth review (colorectal cancer surgery, hysterectomy, gastrointestinal oncological resection, hepatic, pancreatic and biliary surgery). Evidence for the clinical effectiveness of RAS versus conventional laparoscopic surgery is mixed across indications and outcomes. In colorectal cancer surgery, for example, evidence was positive for conversion rate and neutral for length of hospital stays, blood loss and postoperative complication and negative for operative time. For hysterectomy, evidence was positive for the length of hospital stays and neutral for operative time, blood loss, conversion rate and postoperative complication. The quality of the included reviews was judged to be critically low.
The currently available evidence of clinical effectiveness is mixed across indications and of low quality.
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