The emerging role of robotics in plastic and reconstructive surgery: a systematic review and meta-analysis

Abstract

The role of robotics has grown exponentially. There is an active interest amongst practitioners in the transferability of the potential benefits into plastic and reconstructive surgery; however, many plastic surgeons report lack of widespread implementation, training, or clinical exposure. We report the current evidence base, and surgical opportunities, alongside key barriers, and limitations to overcome, to develop the use of robotics within the field. This systematic review of PubMed, Medline, and Embase has been conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PROSPERO (ID: CRD42024524237). Preclinical, educational, and clinical articles were included, within the scope of plastic and reconstructive surgery. 2, 181, articles were screened; 176 articles met the inclusion criteria across lymph node dissection, flap and microsurgery, vaginoplasty, craniofacial reconstruction, abdominal wall reconstruction and transoral robotic surgery (TOR). A number of benefits have been reported including technical advantages such as better visualisation, improved precision and accuracy, and tremor reduction. Patient benefits include lower rate of complications and quicker recovery; however, there is a longer operative duration in some categories. Cost presents a significant barrier to implementation. Robotic surgery presents an exciting opportunity to improve patient outcomes and surgical ease of use, with feasibility for many subspecialities demonstrated in this review. However, further higher quality comparative research with careful case selection, which is adequately powered, as well as the inclusion of cost-analysis, is necessary to fully understand the true benefit for patient care, and justification for resource utilisation.

Keywords: Plastic and reconstructive surgery; Robotic; Robotic assisted.

Fig. 1

Robotic equipment utilised within clinical practice. All three are controlled by a separate master console

Fig. 2

PRISMA flow diagram of the literature search for robotics in plastic and reconstructive surgery

Fig. 3

Total number of articles in each subcategory within the scope of robotic plastic and reconstructive surgery

Fig. 4

Weighted analysis of comparative studies reviewing complication rate of robotic nipple sparing mastectomy with conventional nipple sparing mastectomy

Fig. 5

Weighted analysis of comparative studies reviewing complication rate between robotic abdominal wall reconstruction and laparoscopic abdominal wall reconstruction

Fig. 6

Weighted analysis of comparative studies reviewing complication rates in robotic versus open abdominal wall reconstruction