Democratization in abdominal ablation therapies: The impact of percutaneous robotic assistance on accuracy-A systematic review.

Abstract

Advances in medical technology have revolutionized minimally invasive procedures. This study aims to determine the status of intra-abdominal ablation therapies, focusing on outcomes regarding technique improvement and benefits related to the learning curve. A systematic search in four databases was performed in March 2024 to identify relevant studies. Endpoints included targeting accuracy, organ efficacy, safety, outcomes and technical advantages regardless of physician experience. A total of 40 studies were included. The robotic technique demonstrated significantly higher accuracy (median 1.75 mm) compared to the freehand technique (median 4.50 mm) (p < 0.05). RFA and MWA were the most frequently used ablation techniques, reaching a rate of 52.5% and liver was the main target organ in 77.5% of the studies. Subgroup analysis showed a median tumor size of 2.30 cm, 1.40 mm for the readjustments and 3.30 mm for accuracy in the freehand technique. For robotic approach, the median tumor size was 1.95 cm, readjustments were 0.55 mm, and accuracy was 1.85 mm, and no statistical difference was identified. Severe adverse events were lower with the robotic approach, and improvement in the learning curve was observed among novice physicians. Robotic-assisted ablation techniques improve accuracy and efficacy compared to freehand techniques and are easier for novices to use. This technology allows novices to achieve similar outcomes to experts, contributing to the democratization of ablation techniques. Nevertheless, more clinical trials and standardized studies are necessary to validate these findings and enable the integration of robotic systems into routine practice.