Robot-assisted coronary artery bypass surgery: a systematic review and meta-analysis of comparative studies

Abstract

Background: Robot-assisted coronary bypass (RCAB) surgery has been proposed as an alternative to conventional coronary artery bypass grafting (C-CABG) for managing coronary heart disease, but the evidence on its performance compared to other existing treatments is unclear. The aim of this study was to assess, through a systematic review of comparative studies, the safety and clinical effectiveness of RCAB compared to C-CABG and other minimally invasive approaches for the treatment of coronary heart disease. Methods: We conducted a systematic review of primary studies in the English-language literature comparing RCAB to existing treatment options (C-CABG, minimally invasive direct coronary artery bypass [MIDCAB] and port-access coronary artery bypass [PA-CAB]) following Cochrane Collaboration guidelines. Meta-analyses were performed where appropriate. Results: We reviewed 13 studies: 11 primary studies of RCAB (v. C-CABG in 7, v. MIDCAB in 3 and v. PA-CAB in 1) and 2 multicentre database studies (RCAB v. non-RCAB). The overall quality of the evidence was low. Most studies showed no significant benefit of RCAB over other treatments in a majority of outcome variables. Meta-analyses showed that RCAB had lower rates of pneumonia or wound infection than C-CABG, and shorter intensive care unit length of stay than C-CABG or MIDCAB. Individual studies showed that RCAB had some better outcomes than C-CABG (ventilation time, transfusion, postoperative pain, hospital length of stay) or MIDCAB (transfusion, postoperative pain, time to return to normal activities, physical functioning and hospital length of stay). The review of the database studies showed that RCAB was statistically superior to non-RCAB approaches in postoperative pain, renal failure, transfusion, reoperation for bleeding, stroke and hospital length of stay; however, the difference between the 2 groups in several of these outcomes was small. Conclusion: Although the findings from this review of comparative studies of RCAB appear promising and suggest that RCAB may offer some benefits to patients, in the absence of randomized controlled trials, these results should be interpreted cautiously.

Nursing Cooperation of a Case of Leonardo's Robot-assisted Off-pump Whole Artery Small Incision Coronary Artery Bypass Grafting

“…At present, various literature reports also indicate that Leonardo's surgical robot is superior to traditional coronary artery bypass surgery in perioperative complications and postoperative recovery [11]. Because there are many and complex objects used in the operation, the instrument nurses involved in the operation are required to be master specialized knowledge and be familiar with the performance and characteristics of the robot system.They should prepare the instruments in advance, be familiar with the operation steps, cooperate with the operation accurately and quickly to shorten the operation time, and ensure the smooth completion of the operation.…”

Comparative efficacy of eight therapeutic methods in the treatment of left main coronary artery disease: a Bayesian network meta-analysis protocol

“…If the key process of operation is not smooth, the above methods are likely to be converted to the sternotomy approach. 11 For HCR, first of all, the sequence of PCI and CABG is currently controversial 14 ; second, the cost of hybrid technology is high, which is difficult for patients to accept and the promotion is limited. 15 Thus, under different circumstances, the best strategy for revascularisation of left main lesions is still controversial.…”

“…With the development of medical technology, other surgical methods for the treatment of coronary heart disease include: minimally invasive under direct vision (MIDCAB), 10 robot-assisted coronary artery bypass grafting (RECAB), 11 total endoscopic coronary artery bypass grafting (TECAB) 12 and hybrid coronary artery revascularisation (HCR), 13 etc.…”

Myocardial surgical revascularization as a subspecialty: to be or not to be, that is the question

“…The field of CABG surgery has not seen a similar transition, but minimal-access, robotic-assisted, and hybrid revascularization techniques have been described. While there are no data from randomized controlled trials, observational studies confirm these methods are safe and effective in selected cases and may positively influence postoperative pain, rate of sternal wound infection, and in-hospital length of stay [36][37][38] . Although these results may look promising when performed in specialized centers by highly skilled surgeons, their up-take by the wider community has been very low, probably due to the added costs, complexity, and steep learning curve [35,[39][40][41][42] [Table 1].…”