Photo Credit: Golovchyn

Robotic-assisted surgery for oncology procedures improves outcomes over minimally invasive surgery and open surgery, reducing complications and mortality.

The da Vinci robotic-assisted surgery (dV-RAS) system offers a slate of perioperative outcome benefits compared with minimally invasive surgery (laparoscopic or video-assisted thoracoscopic surgery [lap/VATS]) and open surgery, according to results from a systematic review and meta-analysis published in the Annals of Surgery.

“The results of this meta-analysis demonstrate the advantages of dV-RAS surgery for oncologic procedures, including a lower risk of conversions, blood transfusions, length of hospital stay, 30-day complications, readmissions, and mortality in comparison to lap/VATS,” Rocco Ricciardi, MD, MPH, and colleagues wrote. “The advantages of dV-RAS in comparison to open surgery were seen for all outcomes studied.”

The systematic review and meta-analysis covered 230 peer-reviewed randomized, prospective, and database investigations that compared dV-RAS with lap/VATS or open surgery across seven oncologic procedures and four specialties. The studies included 1.2 million patients who underwent dV-RAS, 1.1 million patients who underwent lap/VATS, and 1.6 million patients who underwent open surgery.

Operating Times & Other Results

According to the meta-analysis, operative time with dV-RAS averaged 17.73 minutes longer than with lap/VATS and 40.92 minutes longer than with open surgery. Hospital stays with dV-RAS, however, were 0.51 days shorter compared with lap/VATS and 1.85 days shorter compared with open surgery. Blood loss was 293.44 mL lower with dV-RAS than with open surgery.

Compared with lap/VATS, odds ratios (ORs) with dV-RAS were lower for conversions to open surgery (0.44), blood transfusions (0.79), postoperative complications (0.90), 30-day readmissions (0.91), and 30-day deaths (0.86). Compared with open surgery, dV-RAS had lower ORs for blood transfusions (0.25), postoperative complications (0.56), 30-day readmissions (0.71), 30-day operations (0.89), and 30-day deaths (0.54).

Clinical Implications

“These 30-day outcomes are meaningful, as ∼25% of postoperative deaths occur after hospital discharge, while readmissions are associated with increased risk of postoperative mortality in high-risk surgical patients (eg, colectomy, lobectomy) …,” the researchers wrote. “Furthermore, this demonstrates that dV-RAS’s shorter length of stay did not translate into greater rates of hospital readmission or postoperative mortality.”

With the FDA’s clearance of the next-generation da Vinci robotic system dV5 and the introduction of competitive systems on the global market, more studies are needed to understand their benefits, the authors advised.

Meanwhile, the results of this study “will be helpful to decision-makers considering the use of robotics in a multispecialty-care setting,” they wrote.