ROBOTIC-ASSISTED SURGERY WITH THE DA VINCI SYSTEM FOR COMPLEX BENIGN PROCEDURES: A COMPARATIVE SYSTEMATIC REVIEW AND META-ANALYSIS
Author(s)
Thomas H. Shin, MD PhD1, Ana Yankovsky, MSc2, Mansi Mathur, MPH3, Neera Patel, MS4, April E. Hebert, PhD5, Usha Kreaden, MSc6, Rocco Ricciardi, MD7.
1University of Virginia School of Medicine, Charlottesville, VA, USA, 2Intuitive Surgical, Palo Alto, CA, USA, 3Intuitive Surgical, Union City, CA, USA, 4Intuitive Surgical, Yorba Linda, CA, USA, 5Intuitive Surgical, San Marcos, CA, USA, 6Intuitive Surgical, Sunnyvale, CA, USA, 7Massachusetts General Hospital, Boston, MA, USA.
1University of Virginia School of Medicine, Charlottesville, VA, USA, 2Intuitive Surgical, Palo Alto, CA, USA, 3Intuitive Surgical, Union City, CA, USA, 4Intuitive Surgical, Yorba Linda, CA, USA, 5Intuitive Surgical, San Marcos, CA, USA, 6Intuitive Surgical, Sunnyvale, CA, USA, 7Massachusetts General Hospital, Boston, MA, USA.
OBJECTIVES: To evaluate clinical and quality-of-life (QoL) outcomes of da Vinci robotic-assisted surgery (dV-RAS) versus laparoscopic (Lap) and open approaches in complex benign procedures.
METHODS: Systematic searches (PROSPERO#CRD420251001402) in PubMed, Scopus, and Embase identified randomized controlled trials (RCTs), database, and comparative cohort studies (2010-2024) across 13 common benign procedures. Complexity was defined by patient anatomy, clinical context (urgent/emergent surgery), or procedure-specific features (advanced disease, intrinsically complex techniques). Outcomes included operative time(OT), transfusions, length of stay(LOS), conversions, perioperative complications, surgical-site-infections(SSI), readmissions, reoperations, and mortality; QoL were 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: Ninety-nine studies representing 104,142 dV-RAS; 562,592 Lap; 22,319 open patients were included (3 RCTs, 6 prospective, 19 database, 71 retrospective); 69 compared dV-RAS with Lap, 19 with open, and 11 with both. Versus Lap, dV-RAS showed lower conversions (OR:0.43[0.27,0.66], p<0.01), intraoperative complications (OR:0.72[0.54,0.94], p=0.02), LOS (MD:-0.18[-0.34,-0.02], p=0.03), 30-day complications (OR:0.83[0.72,0.95], p<0.01), 30-day VAS pain (MD:-2.32[-2.54,-2.10], p<0.01) and RTW (MD:-3.26[-4.04,-2.47], p<0.01), but longer OT (MD:27.35[18.35,36.34], p<0.01).Blood transfusion, SSI, readmissions, reoperations, pain medication use, and mortality were comparable; ADL data were insufficient. Versus open surgery, dV-RAS reduced intraoperative complications (OR:0.60[0.42,0.85], p<0.01), transfusions (OR:0.37[0.30,0.45], p<0.01), LOS (MD:-2.40[-3.19,-1.61], p<0.01), 30-day complications (OR:0.52[0.36,0.73], p<0.01), SSI (OR:0.34[0.27,0.44], p<0.01), readmissions (OR:0.75[0.64,0.87], p<0.01), and mortality (RD:-0.0142[-0.0203,-0.0080], p<0.01), but longer OT (MD:43.98[15.22,72.74], p<0.01). reoperations were similar, and QoL data were limited. Risk of bias was moderate-to-high from confounding and limited RCT evidence.
CONCLUSIONS: Across 13 complex benign procedures, dV-RAS was associated with improved perioperative outcomes versus laparoscopy and open surgery, with fewer conversions, complications, and shorter LOS; however, evidence is largely observational with limited QoL data, warranting higher level of evidence studies to address the evidence gap in complex benign surgery.
METHODS: Systematic searches (PROSPERO#CRD420251001402) in PubMed, Scopus, and Embase identified randomized controlled trials (RCTs), database, and comparative cohort studies (2010-2024) across 13 common benign procedures. Complexity was defined by patient anatomy, clinical context (urgent/emergent surgery), or procedure-specific features (advanced disease, intrinsically complex techniques). Outcomes included operative time(OT), transfusions, length of stay(LOS), conversions, perioperative complications, surgical-site-infections(SSI), readmissions, reoperations, and mortality; QoL were 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: Ninety-nine studies representing 104,142 dV-RAS; 562,592 Lap; 22,319 open patients were included (3 RCTs, 6 prospective, 19 database, 71 retrospective); 69 compared dV-RAS with Lap, 19 with open, and 11 with both. Versus Lap, dV-RAS showed lower conversions (OR:0.43[0.27,0.66], p<0.01), intraoperative complications (OR:0.72[0.54,0.94], p=0.02), LOS (MD:-0.18[-0.34,-0.02], p=0.03), 30-day complications (OR:0.83[0.72,0.95], p<0.01), 30-day VAS pain (MD:-2.32[-2.54,-2.10], p<0.01) and RTW (MD:-3.26[-4.04,-2.47], p<0.01), but longer OT (MD:27.35[18.35,36.34], p<0.01).Blood transfusion, SSI, readmissions, reoperations, pain medication use, and mortality were comparable; ADL data were insufficient. Versus open surgery, dV-RAS reduced intraoperative complications (OR:0.60[0.42,0.85], p<0.01), transfusions (OR:0.37[0.30,0.45], p<0.01), LOS (MD:-2.40[-3.19,-1.61], p<0.01), 30-day complications (OR:0.52[0.36,0.73], p<0.01), SSI (OR:0.34[0.27,0.44], p<0.01), readmissions (OR:0.75[0.64,0.87], p<0.01), and mortality (RD:-0.0142[-0.0203,-0.0080], p<0.01), but longer OT (MD:43.98[15.22,72.74], p<0.01). reoperations were similar, and QoL data were limited. Risk of bias was moderate-to-high from confounding and limited RCT evidence.
CONCLUSIONS: Across 13 complex benign procedures, dV-RAS was associated with improved perioperative outcomes versus laparoscopy and open surgery, with fewer conversions, complications, and shorter LOS; however, evidence is largely observational with limited QoL data, warranting higher level of evidence studies to address the evidence gap in complex benign surgery.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
MT18
Topic
Clinical Outcomes, Medical Technologies, Study Approaches
Disease
Reproductive & Sexual Health, Surgery, Urinary/Kidney Disorders