A Systematic Literature Review and Meta-Analysis of Pan-European Evidence of Robotic-Assisted Surgery using the Da Vinci Surgical System
Author(s)
Ana Yankovsky, MSc1, Neera Patel, MS2, April E. Hebert, PhD2, Usha Kreaden, MSc2;
1Intuitive Surgical, Manager, Global Evidence and Access Management, Sunnyvale, CA, USA, 2Intuitive Surgical, Sunnyvale, CA, USA
1Intuitive Surgical, Manager, Global Evidence and Access Management, Sunnyvale, CA, USA, 2Intuitive Surgical, Sunnyvale, CA, USA
Presentation Documents
OBJECTIVES: To compare the perioperative outcomes of da Vinci robotic-assisted surgery (dV-RAS) with laparoscopic (LAP) or open surgery for 7 malignant procedures for the European population.
METHODS: PubMed, Scopus and EMBASE were systematically searched from 2010 to December 31, 2022 following PRISMA guidelines (PROSPERO#CRD42023466759). Studies published on European patients undergoing radical prostatectomy, partial nephrectomy, hysterectomy, lobectomy, right colectomy, or rectal resection for cancer were included. Data from randomized, prospective, and database studies were pooled as odds ratios (OR) or mean differences (MD) in R using fixed-effect or random-effects (heterogeneity significant). Bias was assessed using ROBINS-I/RoB 2 tools.
RESULTS: Seventy-eight studies (13 randomized, 42 prospective, 23 database) satisfied eligibility criteria, involving 124,389 dV-RAS, 63,073 LAP, and 191,528 open patients. Sixteen European countries were represented, with the top three countries contributing 14 (Italy), 11 (France) and 10 (UK) studies. Compared to LAP, dV-RAS patients were less likely to undergo a conversion (OR=0.51[0.38,0.70],p<0.01), to receive a blood transfusion (OR=0.65[0.60,0.70],p<0.01), or to be readmitted to the hospital (OR=0.71[0.55,0.92],p=0.01), and had a shorter hospital stay (MD=-0.50[0.80,0.20],p<0.01). The dV-RAS group had similar operative times and similar 30-day postoperative complication, reoperation, and mortality rates as LAP. When compared to open surgery, dV-RAS patients had fewer blood transfusions (OR=0.19[0.16,0.23],p<0.01), 30-day postoperative complications (OR=0.58[0.41,0.82],p<0.01), readmissions (OR=0.50[0.41,0.62],p<0.01), and deaths (OR=0.61[0.40,0.93],p<0.01), and a shorter length of stay (MD=-2.09[-2.50,-1.68],p<0.01). The dV-RAS group had similar 30-day reoperation rates and a longer operative time (MD = 49.79 [34.24, 65.35], p<0.01) versus the open approach.
CONCLUSIONS: Available evidence for European population concludes that dV-RAS is better or equivalent to LAP or open for select perioperative outcomes for 7 malignant procedures. These findings should be taken into consideration by researchers, payers, policy makers and Health Technology Agencies in their decision-making processes.
METHODS: PubMed, Scopus and EMBASE were systematically searched from 2010 to December 31, 2022 following PRISMA guidelines (PROSPERO#CRD42023466759). Studies published on European patients undergoing radical prostatectomy, partial nephrectomy, hysterectomy, lobectomy, right colectomy, or rectal resection for cancer were included. Data from randomized, prospective, and database studies were pooled as odds ratios (OR) or mean differences (MD) in R using fixed-effect or random-effects (heterogeneity significant). Bias was assessed using ROBINS-I/RoB 2 tools.
RESULTS: Seventy-eight studies (13 randomized, 42 prospective, 23 database) satisfied eligibility criteria, involving 124,389 dV-RAS, 63,073 LAP, and 191,528 open patients. Sixteen European countries were represented, with the top three countries contributing 14 (Italy), 11 (France) and 10 (UK) studies. Compared to LAP, dV-RAS patients were less likely to undergo a conversion (OR=0.51[0.38,0.70],p<0.01), to receive a blood transfusion (OR=0.65[0.60,0.70],p<0.01), or to be readmitted to the hospital (OR=0.71[0.55,0.92],p=0.01), and had a shorter hospital stay (MD=-0.50[0.80,0.20],p<0.01). The dV-RAS group had similar operative times and similar 30-day postoperative complication, reoperation, and mortality rates as LAP. When compared to open surgery, dV-RAS patients had fewer blood transfusions (OR=0.19[0.16,0.23],p<0.01), 30-day postoperative complications (OR=0.58[0.41,0.82],p<0.01), readmissions (OR=0.50[0.41,0.62],p<0.01), and deaths (OR=0.61[0.40,0.93],p<0.01), and a shorter length of stay (MD=-2.09[-2.50,-1.68],p<0.01). The dV-RAS group had similar 30-day reoperation rates and a longer operative time (MD = 49.79 [34.24, 65.35], p<0.01) versus the open approach.
CONCLUSIONS: Available evidence for European population concludes that dV-RAS is better or equivalent to LAP or open for select perioperative outcomes for 7 malignant procedures. These findings should be taken into consideration by researchers, payers, policy makers and Health Technology Agencies in their decision-making processes.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
CO128
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
SDC: Oncology, STA: Surgery