244 Major Laparoscopic Versus Robotic Surgery – a Systematic Review of Randomised Controlled Trials

Abstract

Abstract Aim To systematically review randomised controlled trials comparing robotic and laparoscopic surgical approaches in major surgery. Method Embase, Medline and Cochrane Library were searched from their inception to September 2022. Included studies were randomised controlled trials comparing robotic and laparoscopic surgery in major general surgical, urological and gynaecological procedures. Short-term, health-related quality-of-life, surgical ergonomics, and long-term outcomes were compared. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Forty-eight studies, across fifteen procedures, involving 7588 patients were included. All of the studies reported non-significant differences in mortality between robotic and laparoscopic surgery. In selected studies, robotic surgery was associated with a lower rate of complication (8.3%, n = 4), shorter length of postoperative stay (10.4%, n = 5), and lower conversion rate (6.3%, n = 3), while laparoscopic surgery was associated with shorter operative time (37.5%, n = 18) and lower total cost (20.8%, n = 13). Eight studies found robotic surgery to be associated with superior health-related quality-of-life outcomes. Only six studies included long-term outcomes, with no significant differences between groups, while two studies reported on surgical ergonomics, one each reporting benefits in laparoscopic and robotic groups. Conclusions Robotic surgery is at least non-inferior in terms of short-term mortality and morbidity when compared to laparoscopic surgery, with potential benefits in post-operative recovery, and patient-reported outcomes, especially apparent in complex resection procedures. Future studies should focus incorporate metrics of surgical ergonomics, long-term outcomes and formal quality-of-life assessment, to further elucidate where the robotic platform can lead to patient benefits, as its adoption increases.