Comparison of robotic camera holders with human assistants in endoscopic surgery: a systematic review and meta-analysis

Abstract

Background Robotic camera holders can overcome the shortcomings of human assistants, such as shaking and accidental rotation in endoscopic surgery. Robotic camera holder is not affected by the operation time and surgical position and reduces the size of the team. However, there is still controversy over the practicality of robotic camera holders. Material and methods We searched PubMed, Web of Science, Embase, Cochrane Library PubMed, Embase, Cochrane Library and Web of Science. The last database search was performed on 30 April 2022. Two reviewers independently reviewed the studies. Results A total of eight studies (n = 698, 354 controls and 344 robotic camera holders) were included in our analysis. The results showed that the robotic camera holder significantly outperformed human assistants on the frequency of lens cleaning (SMD, −0.48; 95% CI, −0.90 to −0.05) and inappropriate movements (MD, −3.57; 95% CI, −4.93 to −2.21). There was no difference in total operation time (MD, 6.99; 95% CI, −2.47 to 16.72), preparation time (MD, 2.43; 95% CI, −0.32 to 5.18) or blood loss (MD, 34.47; 95% CI, −8.05 to 76.98) between the robotic camera holder and human assistant. However, the robotic camera holder was significantly slower in the core operation (MD, 5.06; 95% CI, 1.18 to 8.94), and surgeons had mixed reviews of robotic systems. Conclusions The robotic camera holder provided the surgeon with a highly stable environment. Although the robotic camera holder will not increase the total time, it still needs to improve the core operation time. There is much room for improvement in robotic camera holders. Further development of devices with intuitive control systems and a greater range of motion will be required to accommodate more complex surgeries.