Morais Maria Clara, de Carvalho Luiza da Silva, Nogueira Raquel, Kasakewitch Joao Pedro G, Perim Victor, Neves Vitor, Faleiro Matheus, Lima Diego L, Smith Vance L
Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil.
Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
J Robot Surg. 2025 Aug 6;19(1):454. doi: 10.1007/s11701-025-02630-9.
Acute care surgery includes urgent non-trauma general surgical emergency, in which minimally invasive approaches, notably laparoscopic, are associated with reduced postoperative morbidity and hospital stay. Although robotic surgery has demonstrated advantages in elective procedures, its safety, feasibility, and applicability across a broad spectrum of acute care conditions remain undefined.
We conducted a systematic review in accordance with PRISMA guidelines, searching PubMed/MEDLINE, EMBASE, Web of Science, and the Cochrane Library from inception to December 2024 for studies analyzing the safety profile of robotic approaches in adult care surgery. Primary outcomes included length of stay, postoperative complications, conversion to open surgery, operative time, 30-day readmission, and mortality.
Our search yielded 3,740 results. After proper analysis, a total of eighteen studies were included (2016-2024; n = 4,439,317), in which robotic approaches showed shorter length of stay (0.7-28.46 vs. 1-38.26 days), lower complication rates (2-25.62% vs. 3.7-46%), and fewer conversions (0-11.5% vs. 0-28.7%) compared to laparoscopy, though operative times were longer (67-323 vs. 46-294.5 min). Procedure-specific trends emerged, particularly to robotic cholecystectomy, concerning fewer complications (0.5-25.62% vs. 8.23-21%) and conversions (0-1.9% vs. 1.9-8.57%).
In this review, robotic surgery appears as a safe and feasible alternative in acute care settings, offering potential advantages in hospital stay, postoperative complications, and conversion rates-especially for cholecystectomy and colectomy-despite longer operative durations. Further randomized trials and cost-effectiveness analyses are warranted to define its optimal role.
Level III, Systematic Review Study.
A review protocol for this systematic review was registered at PROSPERO CRD420251025085.
急性护理手术包括紧急非创伤性普通外科急症，其中微创方法，尤其是腹腔镜手术，与术后发病率降低和住院时间缩短相关。尽管机器人手术在择期手术中已显示出优势，但其在广泛的急性护理情况下的安全性、可行性和适用性仍不明确。
我们按照PRISMA指南进行了系统评价，检索了从创刊至2024年12月的PubMed/MEDLINE、EMBASE、Web of Science和Cochrane图书馆，以查找分析机器人手术方法在成人护理手术中安全性的研究。主要结局包括住院时间、术后并发症、转为开放手术、手术时间、30天再入院率和死亡率。
我们的检索产生了3740条结果。经过适当分析，共纳入18项研究（2016 - 2024年；n = 4439317），其中机器人手术方法与腹腔镜手术相比，住院时间更短（0.7 - 28.46天对1 - 38.26天）、并发症发生率更低（2 - 25.62%对3.7 - 46%）、转为开放手术的比例更少（0 - 11.5%对0 - 28.7%），尽管手术时间更长（67 - 323分钟对46 - 294.5分钟）。出现了特定手术的趋势，特别是机器人胆囊切除术，其并发症（0.5 - 25.62%对8.23 - 21%）和转为开放手术的比例（0 - 1.9%对1.9 - 8.57%）更少。
在本评价中，机器人手术在急性护理环境中似乎是一种安全可行的替代方法，尽管手术持续时间较长，但在住院时间、术后并发症和转化率方面具有潜在优势，尤其是对于胆囊切除术和结肠切除术。需要进一步的随机试验和成本效益分析来确定其最佳作用。
三级，系统评价研究。
本系统评价的方案已在PROSPERO CRD420251025085注册。
