The perioperative outcomes of uniportal robotic-assisted thoracic surgeries-a systematic review and meta-analysis of surgical cohort studies and case reports

Abstract

Background: Early results have illustrated the multiportal robotic approach to be safe and oncologically efficacious in the treatment of thoracic malignancies. Industry leaders have improved upon the lessons learned during the early multiportal studies and have now come to establish the feasibility of the biportal, and subsequently the uniportal robotic-assisted approach, all in an effort to offer patients equivalent or better outcomes with less surgical trauma. No current, coherent body of evidence currently exists outlining the early-term outcomes of patients undergoing uniportal robotic-assisted thoracic surgery. This systematic review and meta-analysis sought to clarify the early-phase outcomes of these patients.

Methods: An electronic search of four databases was performed to identify relevant studies outlining the immediate post-operative outcomes of patients undergoing uniportal robotic-assisted thoracic surgeries. The primary endpoint was defined as technical success (i.e., no conversion to secondary robotic, video-assisted thoracoscopic, or open approaches). Secondary endpoints of interest included post-operative outcomes and complication rates. A meta-analysis using a random effects model of proportions or means was applied, as appropriate.

Results: The search strategy ultimately yielded 12 relevant studies for inclusion. A total of 240 patients (52% male) split across cohort studies and case reports were identified. The mean age of the two groups was 59.7±3.0 and 58.1±6.8 years, respectively. The mean operative time was 133.8±38.2 and 150.0±52.2 minutes, respectively. Length of hospital stay was 4.4±1.6 and 4.3±1.1 days, respectively. The mean blood loss was 80.0±25.1 mL The majority of identified procedures were lobectomies, segmentectomies, and wedge resections, though complex sleeve resections and anterior mediastinal mass resections were also completed. Cumulative technical success was 99.9%.

Conclusions: The uniportal robotic-assisted approach, when completed in expert hands, has been illustrated to have exceedingly low rates of conversion to secondary procedures, along with short length of stay (LOS), minimal blood loss, and short procedural times (variable depending on operation type). Current evidence on the feasibility of this approach will be bolstered by upcoming multi-institutional series.

Keywords: Robotic thoracic surgery; early outcomes; lobectomy; wedge resection.

Figure 1

Risk of bias domains visual representation tool—ROBINS-I. OBINS-I, Risk of Bias in Non-randomized Studies - of Interventions.

Figure 2

Risk of bias overall risk assessment—ROBINS-I. OBINS-I, Risk of Bias in Non-randomized Studies - of Interventions.

Figure 3

Funnel plot for mean operating time. Test for funnel plot asymmetry: t=0.1324, df=3, P=0.9030. Limit estimate (as sei >0): b=122.6786 (95% CI: 23.7557, 221.6016). Kendall’s tau =0.0000, P=1.0000.

Figure 4

Funnel plot for mean LOS. Test for funnel plot asymmetry: t=0.1254, df=3, P=0.9081. Limit estimate (as sei >0): b=4.5994 (95% CI: 2.7533, 6.4455). Kendall’s tau =0.2000, P=0.8167. LOS, length of stay

Figure 5

Funnel plot for blood loss.