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Surgery
Original research
Clinical effectiveness of robotic versus laparoscopic and open surgery: an overview of systematic reviews
  1. Tzu-Jung Lai1,
  2. Campbell Roxburgh2,
  3. Kathleen Anne Boyd1,
  4. Janet Bouttell1
  1. 1Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
  2. 2School of Cancer Sciences, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
  1. Correspondence to Ms Tzu-Jung Lai; t.lai.1{at}research.gla.ac.uk

Abstract

Objective To undertake a review of systematic reviews on the clinical outcomes of robotic-assisted surgery across a mix of intracavity procedures, using evidence mapping to inform the decision makers on the best utilisation of robotic-assisted surgery.

Eligibility criteria We included systematic reviews with randomised controlled trials and non-randomised controlled trials describing any clinical outcomes.

Data sources Ovid Medline, Embase and Cochrane Library from 2017 to 2023.

Data extraction and synthesis We first presented the number of systematic reviews distributed in different specialties. We then mapped the body of evidence across selected procedures and synthesised major findings of clinical outcomes. We used a measurement tool to assess systematic reviews to evaluate the quality of systematic reviews. The overlap of primary studies was managed by the corrected covered area method.

Results Our search identified 165 systematic reviews published addressing clinical evidence of robotic-assisted surgery. We found that for all outcomes except operative time, the evidence was largely positive or neutral for robotic-assisted surgery versus both open and laparoscopic alternatives. Evidence was more positive versus open. The evidence for the operative time was mostly negative. We found that most systematic reviews were of low quality due to a failure to deal with the inherent bias in observational evidence.

Conclusion Robotic surgery has a strong clinical effectiveness evidence base to support the expanded use of robotic-assisted surgery in six common intracavity procedures, which may provide an opportunity to increase the proportion of minimally invasive surgeries. Given the high incremental cost of robotic-assisted surgery and longer operative time, future economic studies are required to determine the optimal use of robotic-assisted surgery capacity.

  • clinical decision-making
  • surgery
  • minimally invasive surgery

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study. All data relevant to the study are included in the article or uploaded as supplementary information.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2023-076750

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    Data availability statement

    Data sharing not applicable as no datasets generated and/or analysed for this study. All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Contributors T-JL: conceptualisation of the study, data synthesis and drafting of the manuscript. CR: critical review of the manuscript and substantial contributions to its intellectual content. KAB: conceptualisation of the study, manuscript review, editing and supervision of the research. JB: conceptualisation of the study, manuscript review, editing and supervision of the research. Each author has reviewed and approved the final version of the manuscript, and each has agreed to be accountable for all aspects of the work, ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. T-JL is responsible for the overall content as guarantor. We can confirm that this manuscript has no AI used in the submission.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.