Clinical Outcomes of Robotic Surgery Compared to Conventional Surgical Approaches (Laparoscopic or Open)

A Systematic Overview of Reviews

Hala Muaddi, MD, MSc; Melanie El Hafid; Woo Jin Choi, MD; Erin Lillie, MSc; Charles de Mestral, MD, PhD; Avery Nathens, MD, PhD; Therese A. Stukel, PhD; Paul J. Karanicolas, MD, PhD


Annals of Surgery. 2021;273(3):467-473. 

In This Article


Eligibility Criteria

The protocol for this overview of reviews was registered with PROSPERO (CRD42019131946). Studies were selected for inclusion if they were systematic reviews that included an evaluation of robotic surgery in comparison to the conventional surgical approach (laparoscopic or open) across any surgical field for resection of benign or malignant disease. Article selection was not limited by outcome. Systematic reviews on computer-modulated surgery or reviews that did not compare robotic surgery to a conventional surgical approach were excluded. Reviews that failed to report on outcomes of robotic procedure separately from other minimally invasive procedures were also excluded. Nonsystematic reviews, and comprehensive reviews, were excluded as we aimed to include the most comprehensive systematic reviews. The grey literature (ie, conference proceedings and abstracts) were excluded as insufficient information is often presented and the final manuscript tends to vary substantially from presented data.[8,9] Non-English reviews were excluded as prior work demonstrated no evidence of bias with the use of language restrictions.[10]

Search Methods for the Identification of Reviews

With the consultation of a librarian, a search strategy was formulated to identify published systematic reviews comparing robotic surgery to conventional surgical approaches in humans. The following databases were searched; MEDLINE, EMBASE, and the Cochrane Central Register of systematic reviews for any studies published from inception to January 2019 in the English language. Data search was then supplemented by hand-searching for recently published systematic reviews since the last systematic search, citation tracking of the included studies and published articles on robotic surgery.

The following search terms were used robot*, or computer assisted or computer-assisted or video assisted, or video-assisted or, remote*, da vinci, or davinci, or Zeus, or laprotek, or probot, or robodoc, or Acrobot, or TGS, or Sensei, or SCARA, or telebot, or Computer Assisted Surgical Planning And Robotics (CASPAR), or spineAssist, or spine assist, or heartlander, or Miniature robot* for surgical procedure*, or Praxiteles, or neuroarm, or surger*, or surgical, or procedure, or resection, or operation, or excision, or dissection, prostatectom*, or hysterectom*, or salpingo-oophorectom*, or trachelectom*, or nephrectom*, or proctectom*, or colectom*, or hemicolectom*, or adrenalectom*, or lobectom*, or pneumonectom*, or segmentectom*, or cholecystectom*, or Nissen fundoplication, or sacrocolpopexy, or hip arthroplasty or knee arthroplasty, AND systematic reviews or meta-analysis or metaanalysis, or original search further limited to systematic reviews.

Study Selections

The titles and abstracts of the literature search citations were screened by independent reviewers (HM, ME, WC) in duplicate using standardized electronic screening forms in DistillerSR software. Inter-rater reliability was assessed using the kappa statistic and a k-score >0.8 was required before proceeding. All conflicts were resolved through discussion. Relevant reports that compare robotic techniques to laparoscopic or open techniques were retrieved.

Given the large number of systematic reviews identified for full text screen, we limited our full text review to systematic reviews published after January 2017. Due to the breadth of surgical specialties and procedures we further limited this overview of reviews to systematic reviews of most commonly performed robotic procedures examining clinical outcomes of radical prostatectomy, hysterectomy, thoracic surgery (lobectomy and thymectomy), colorectal resection, nephrectomy, gastric, or hepatopancreaticobiliary procedures. We identified 1 protocol planning to examine outcomes after total hysterectomy for benign procedures. Given that there were no systematic reviews examining this common procedure after January 2017 we included the most recently published systematic review.

Synthesis of Results

We divided the search results by procedure and examined the systematic reviews for each procedure in reverse chronological order from date of publication. The most recently published reviews with a systematic comprehensive search evaluating a broad range of clinical outcomes were included.

Given the large clinical and methodological heterogeneity in the patient population and procedures we synthesized results qualitatively and developed a descriptive summary for each procedure identified. When possible, we further limited the included studies to RCTs to focus on examining the effectiveness of robotic surgery compared to laparoscopic or open surgery.