PAN-EUROPEAN EVIDENCE OF ROBOTIC-ASSISTED SURGERY USING THE DA VINCI SURGICAL SYSTEM FOR BENIGN PROCEDURES: A SYSTEMATIC LITERATURE REVIEW AND META-ANALYSIS
Author(s)
Mansi Mathur, MPH1, Ana Yankovsky, MSc2, Neera Patel, MS3, April E. Hebert, PhD4, Usha Kreaden, MSc5.
1Intuitive Surgical, Union City, CA, USA, 2Intuitive Surgical, Palo Alto, CA, USA, 3Intuitive Surgical, Yorba Linda, CA, USA, 4Intuitive Surgical, San Marcos, CA, USA, 5Intuitive Surgical, Sunnyvale, CA, USA.
1Intuitive Surgical, Union City, CA, USA, 2Intuitive Surgical, Palo Alto, CA, USA, 3Intuitive Surgical, Yorba Linda, CA, USA, 4Intuitive Surgical, San Marcos, CA, USA, 5Intuitive Surgical, Sunnyvale, CA, USA.
OBJECTIVES: To evaluate clinical and quality-of-life (QoL) outcomes after benign da Vinci robotic-assisted surgery (dV-RAS) within the European population compared to laparoscopic (Lap) or open surgery.
METHODS: A systematic literature review (PROSPERO#CRD420251001402) in PubMed, Scopus, and Embase identified randomized controlled trials(RCTs), database, and comparative cohort studies(2010-2024). Data across 13 benign gynecologic, general, urologic, bariatric, and colorectal procedures were included. Outcomes assessed were operative time(OT), transfusions, length of stay(LOS), conversions, perioperative complications, surgical-site-infections(SSI), readmissions, reoperations, and mortality; QoL outcomes included pain, pain medication use, return to daily activities(ADL), and return to work(RTW). Meta-analysis used R to estimate pooled odds ratios(OR) or mean differences(MD) with fixed/random-effects models; bias was assessed using ROBINS-I and RoB 2.
RESULTS: Seventy-one studies (2 RCTs, 8 prospective, 7 database, 54 retrospective), included 16,047 dV-RAS, 48,464 Lap, and 43,913 open patients. Fifty-one compared dV-RAS with Lap, 8 with open, and 12 all three; 13 European countries were represented, led by Italy(17), France(10), and Germany(8). Compared with Lap, dV-RAS was associated with lower conversions (OR:0.19[0.15,0.25], p<0.01), intraoperative complications (OR:0.58[0.42,0.81], p=0.17), LOS (MD:-0.37[-0.68,-0.07], p=0.02), 30-day complications (OR:0.79[0.67,0.92], p<0.01) and 30-day VAS pain (MD:-2.13[-2.95,-1.32], p<0.01), but longer OT (MD:19.78[9.17,30.39], p<0.01); other perioperative and QoL outcomes were comparable. Compared with open, dV-RAS was associated with shorter LOS (MD:-1.98[-2.61,-1.35]; p<0.01), fewer transfusions (OR:0.38[0.30,0.47], p<0.01), 30-day complications (OR:0.54[0.31,0.96], p=0.04) and 30-day SSI (OR:0.18[0.05,0.58], p<0.01) but longer OT (MD:49.01[15.16,82.87], p<0.01). Intraoperative complications, 30-day readmission, reoperation, and mortality were similar; QoL evidence was limited. Risk of bias was moderate-to-high, driven by confounding and limited RCT evidence.
CONCLUSIONS: A Pan-European meta-analysis across 13 benign procedures found dV-RAS to be associated with improved outcomes versus laparoscopic and open surgery, including fewer conversions, postoperative complications, and shorter LOS. While evidence is largely retrospective the current study highlights the need for higher level of evidence studies including QoL outcomes in benign surgical practice.
METHODS: A systematic literature review (PROSPERO#CRD420251001402) in PubMed, Scopus, and Embase identified randomized controlled trials(RCTs), database, and comparative cohort studies(2010-2024). Data across 13 benign gynecologic, general, urologic, bariatric, and colorectal procedures were included. Outcomes assessed were operative time(OT), transfusions, length of stay(LOS), conversions, perioperative complications, surgical-site-infections(SSI), readmissions, reoperations, and mortality; QoL outcomes included pain, pain medication use, return to daily activities(ADL), and return to work(RTW). Meta-analysis used R to estimate pooled odds ratios(OR) or mean differences(MD) with fixed/random-effects models; bias was assessed using ROBINS-I and RoB 2.
RESULTS: Seventy-one studies (2 RCTs, 8 prospective, 7 database, 54 retrospective), included 16,047 dV-RAS, 48,464 Lap, and 43,913 open patients. Fifty-one compared dV-RAS with Lap, 8 with open, and 12 all three; 13 European countries were represented, led by Italy(17), France(10), and Germany(8). Compared with Lap, dV-RAS was associated with lower conversions (OR:0.19[0.15,0.25], p<0.01), intraoperative complications (OR:0.58[0.42,0.81], p=0.17), LOS (MD:-0.37[-0.68,-0.07], p=0.02), 30-day complications (OR:0.79[0.67,0.92], p<0.01) and 30-day VAS pain (MD:-2.13[-2.95,-1.32], p<0.01), but longer OT (MD:19.78[9.17,30.39], p<0.01); other perioperative and QoL outcomes were comparable. Compared with open, dV-RAS was associated with shorter LOS (MD:-1.98[-2.61,-1.35]; p<0.01), fewer transfusions (OR:0.38[0.30,0.47], p<0.01), 30-day complications (OR:0.54[0.31,0.96], p=0.04) and 30-day SSI (OR:0.18[0.05,0.58], p<0.01) but longer OT (MD:49.01[15.16,82.87], p<0.01). Intraoperative complications, 30-day readmission, reoperation, and mortality were similar; QoL evidence was limited. Risk of bias was moderate-to-high, driven by confounding and limited RCT evidence.
CONCLUSIONS: A Pan-European meta-analysis across 13 benign procedures found dV-RAS to be associated with improved outcomes versus laparoscopic and open surgery, including fewer conversions, postoperative complications, and shorter LOS. While evidence is largely retrospective the current study highlights the need for higher level of evidence studies including QoL outcomes in benign surgical practice.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
MT17
Topic
Clinical Outcomes, Medical Technologies, Study Approaches
Disease
Reproductive & Sexual Health, Surgery, Urinary/Kidney Disorders