A Systematic Review and Meta-Analysis of the Effectiveness and Cost of Single-Site Robotic Surgery and Single-Site Laparoscopic Surgery in Gynecological Diseases: The Era of Single-Site Robotic Surgery May Have Arrived

Background

The existing research data cannot fully prove the advantages of single-site Da Vinci robotic surgery (RSS) compared with single-site laparoscopic surgery (LESS) in the treatment of gynecological diseases.

Aims

To evaluate the effectiveness and cost of RSS and LESS in the treatment of gynecological diseases. To provide a theoretical basis for RSS to replace LESS in the treatment of gynecological diseases.

Methods and Results

A systematic search of PubMed, EMbase, and Wanfang (万方), three electronic databases for articles published up to December 31st, 2023, was performed by computer. After literature screening, data extraction, and quality evaluation according to inclusion and exclusion criteria, a meta-analysis was performed using RevMan 5.1 software. A total of 16 articles were included, including 14 articles on effectiveness, with 2315 patients, and 2 articles on cost, with 544 patients. Compared with LESS, RSS was associated with a shorter total operative time for malignant tumor surgery (107 patients MD −24.01 min, 95% CI −32.40 to −15.62, p < 0.00001), less estimated blood loss (107 patients MD −53.60 mL, 95% CI −105.50 to −1.69, p = 0.04), and there was no significant difference in postoperative hospital days and postoperative complications between the two groups. The subgroup analysis of total operative time was carried out separately according to the time of study publication and different single-point ports and robotic surgical systems. After 2020 and for using commercial single-point ports other than the Da Vinci dedicated single-point port, or using the fourth-generation Da Vinci SP surgical system, there was no significant difference in total operative time between the two groups (1259 patients MD 16.91 min, 95% CI −9.38 to 43.19, p = 0.21) (354 patients MD 34.13 min, 95% CI −16.75 to 85.01, p = 0.19) and (645 patients MD 13.79 min, 95% CI −26.85 to 54.43, p = 0.51, respectively).

Conclusion

The present meta-analysis supports that, compared with LESS, in gynecological malignant tumor surgery, RSS takes shorter total operating time, less estimated blood loss, and has similar efficacy in postoperative hospital days and postoperative complications. However, the total hospital costs of RSS are higher than those of LESS. Therefore, if the cost of RSS can be reduced, RSS is a feasible surgical method for patients undergoing gynecological malignant tumor surgery. With the continuous updating of equipment and instruments and the widespread use of the fourth-generation Da Vinci SP surgical system, the era of single-site robotic surgery may be ushered in after 2020. However, due to certain limitations of this study, the above results must be interpreted with caution.