A comparison of perioperative outcomes for da Vinci robotic-assisted, laparoscopic and open surgery in oncologic procedures: a systematic literature review and meta-analysis of evidence from China.
Xuefeng Hu, Usha Seshadri-Kreaden, Ana Yankovsky et al.
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In 30 seconds
This systematic review and meta-analysis pooled 116 comparative studies published from 2010 to 2024 on da Vinci robot-assisted surgery (dV-RAS) versus laparoscopic/video-assisted thoracoscopic surgery (LAP/VATS) or open surgery across seven oncologic procedures in China. Compared with LAP/VATS, dV-RAS was associated with lower odds of conversion to open surgery (OR 0.26; 95% CI 0.21-0.33; p < 0.01), as well as advantages in several other perioperative outcomes. Comparisons with open surgery also favored dV-RAS for selected outcomes, while operative time, readmission, and 30-day mortality did not differ significantly.
Key findings
- Compared with LAP/VATS, dV-RAS was associated with lower odds of conversion to open surgery (OR 0.26; 95% CI 0.21-0.33; p < 0.01).
- Relative to LAP/VATS, dV-RAS was associated with less blood loss (MD - 32.48 mL; 95% CI - 40.86 to - 24.11; p < 0.01) and a shorter hospital stay (MD - 1.06 days; 95% CI - 1.30 to - 0.82; p < 0.01).
- Compared with LAP/VATS, dV-RAS was associated with fewer postoperative complications (OR 0.67; 95% CI 0.61-0.73; p < 0.01) and reoperations (OR 0.62; 95% CI 0.40-0.96; p = 0.03).
- Operative time, readmission, and 30-day mortality did not differ significantly between approaches.
Why it matters
The pooled findings suggest that robotic approaches may offer perioperative advantages across several cancer operations, including less blood loss and fewer complications, without a demonstrated difference in operative time or short-term mortality. These comparisons can inform evaluation of surgical approaches, but the evidence does not establish that robotics causes better outcomes or that the findings apply beyond the studied Chinese settings and procedures.
What to keep in mind
Between-study heterogeneity was substantial, and most included studies were retrospective; the authors call for confirmation in higher-quality prospective research.