OBJECTIVES: Randomized controlled trials (RCT) are the “Gold standard” for assessing medical devices; however, there is a paucity of RCTs and typical hospital programs offer multispecialty robotic surgery. Therefore, we compared a set of common clinical outcomes for robotic, laparoscopic, and open surgery across multiple specialties.

METHODS: A systematic literature review (using PRISMA) and meta-analysis (using RevMan 5.4) was performed. Randomized controlled trials involving robotic surgery performed with da Vinci Surgical systems published in PubMed, Embase, and Scopus from January 1, 2010 to August 4, 2022 were included. Exclusion criteria were language not English, pediatric population, benign procedures, no outcomes of interest, or redundant data. Primary outcomes were operative time, conversions, transfusions, length of hospital stay, postoperative complications, reoperations, readmission, and mortality within 30-days (Prospero #CRD42022374854).

RESULTS: The search identified 44 RCTs across urology, gynecology, colorectal, thoracic, general surgery, and head & neck specialties for cancer indications. Compared to open surgery, robotic-assisted surgery resulted in fewer transfusions (OR 0.41 [0.29, 0.57], p<0.00001) and postoperative complications (OR 0.60 [0.44, 0.80], p=0.0006), and a shorter hospital stay (WMD -1.00 [-1.65, -0.35], p=0.003). Compared to laparoscopic surgery, robotic-assisted surgery resulted in fewer conversions (RD -0.0123 [-0.0245, -0.0001, p=0.049) and a shorter hospital stay (WMD -0.57 [-0.92, -0.21], p=0.002). There were no differences in transfusions or postoperative complications. Operative time was significant in favor of laparoscopic (WMD 27.76 [15.92, 39.60], p<0.00001) and open (WMD 56.94 [36.48, 77.39], p<0.00001) surgery. There was no difference in readmission, reoperation, or mortality for either comparison.

CONCLUSIONS: Our meta-analysis of available RCTs using the da Vinci surgical systems for cancer procedures has shown similar or superior surgical outcomes for robotic assisted surgery compared to open or laparoscopic surgery across 6 specialties. These findings can help policy makers and healthcare providers evaluate robotic-assisted surgery from a multispecialty perspective.