Safety and Effectiveness of Da Vinci Surgical System: A Rapid Review<sup>△</sup>_Chinese Journal of Evidence-Based Medicine

Authors：

 YUJia-jie ^1,2 , WANGYing-qiang ³ ,  LIYou-ping ¹ , LIXiang-lian ¹ , LICui-cui ⁴ , SHENJian-tong ⁵

1. Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China;
2. West China School of Medicine, Sichuan University, Chengdu 610041, China;
3. Department of Medical Administration, 363^rd Hospital, Chengdu 610041, China;
4. Nuclear Industry 416^th Hospital, Chengdu 610051, China;
5. Medical School of Huzhou Teachers College, Huzhou 313000, China;

Corresponding author：

LIYou-ping, Email: yzmylab@hotmail.com

Keywords：

Da Vinci surgical system; Safety; Effectiveness; Rapid review; Health technology assessment

DOI：

10.7507/1672-2531.20140092

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objectives The primary objectives of this rapid health technology assessment (RHTA) were to assess the safety and effectiveness of Da Vinci surgical system compared with traditional e surgeries, so as to provide the currently-available best evidence for health decision makers and clinical workers. Methods A comprehensive search of electronic databases (EMbase, PubMed, The Cochrane Library, Web of Science, CNKI, VIP, CBM and WanFang Data) and relevant professional HTA websites were conducted from inceptionto October 9, 2012. Two reviews independently screen literature according to the inclusion and exclusion criteria, extracted data, and assess the quality of included studies. The data based on secondary studies were reported, and a final recommendation and its level was made based on assessment outcome. Results A total of 21 studies were included, encompassing 7 HTAs and 14 systematic reviews/metaanalyses. The included studies involved radical prostatectomy, hysterectomy, nephrectomy, coronary artery bypass graft, and gastric fundoplication. Though the included HTAs and systematic reviews/meta-analyses focus on different diseases, the outcomes showed significant differences existed between Da Vinci surgical system and other routine surgery in clinical effectiveness and safety of different diseases. Compared with routine surgery, Da Vinci surgical system shortened hospital stay; decreased operation conversion rates, blood loss and blood transfusion rates during surgery; but it increased operative time. Besides, compared with traditional laparoscopic surgery, Da Vinci surgical system shortened operation time and hospital stay, and decreased operation conversion rates, blood loss and blood transfusion rates during surgery. Conclusion Current evidence shows that the clinical effectiveness and safety outcomes of Da Vinci surgical system differ in diseases. Currently, most included HTAs and systematic reviews/meta-analyses are based on observational studies, relevant prospective randomized controlled trials lack, and the evidence is graded as low quality, health decision makers are suggested to apply this evidence with caution on the basis of comprehensive consideration.

Citation： YUJia-jie, WANGYing-qiang, LIYou-ping, LIXiang-lian, LICui-cui, SHENJian-tong. Safety and Effectiveness of Da Vinci Surgical System: A Rapid Review^△. Chinese Journal of Evidence-Based Medicine, 2014, 14(5): 530-540. doi: 10.7507/1672-2531.20140092 Copy

1.	嵇武, 李宁, 黎介寿.我国手术机器人外科面临的机遇和挑战.中国微创外科杂志, 2012, 12(7):577-579.
2.	Da vinci changing the experience of Surgery. Intuitive Surgical. Available at: http://www.davincisurgery.com/.
3.	Barbash GI, Glied SA. New Technology and Health Care Costs-The Case of Robot-Assisted Surgery. N Engl J Med, 2010, 363(8):701-704.
4.	Steinberg PL, Merguerian PA, Bihrle W, et al. The cost of learning robotic-assisted prostatectomy. Urology, 2008, 72(5):1068-1072.
5.	Health Information and Quality Authority. Health technology assessment of robot-assisted surgery in selected surgical procedures. Ireland. 2011. Available at: http://www.hiqa.ie/publications/healthtechnology-assessment-robot-assisted-surgery-selected-surgicalprocedures.
6.	Tooher R, Pham C. Da Vinci surgical robotic system:technology overview (Structured abstract). HTA Database, 2004.
7.	Tsakonas E, Nkansah E. The da Vinci surgical robotic system:a review of the clinical and cost-effectiveness (Structured abstract). Available at: http://www.crd.york.ac.uk/NIHR_CRDWEB/ShowRecord.asp?LinkFrom=OAI&ID=32011001301#.Us-zjnDUOrQ.
8.	Chuong H, Eva T, Khai T, et al. Robot-assisted surgery versus open surgery and laparoscopic surgery:clinical and cost-effectiveness analyses (Project record). Available at: http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?LinkFrom=OAI&ID=32011000303#.UszxXDUOrQ.
9.	Llanos-Mendez A, Villegas P. Robotic surgery using the da Vinci robotic telemanipulation system in hysterectomy (Structured abstract). Available at: http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?LinkFrom=OAI&ID=32011000513#.Us-zCHDUOrQ.
10.	Llanos-Mendez A, Villegas P. Robotic surgery by means of the da Vinci robotic telemanipulation system in general and digestive surgery (Structured abstract). Available at: http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?LinkFrom=OAI&ID=32011000512#.Usz6XDUOrQ.
11.	Llanos-Mendez A, Villegas P. Robotic surgery using the da Vinci robotic telemanipulation system in hysterectomy (Structured abstract). Available at: http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?LinkFrom=OAI&ID=32011000513#.Us-0OXDUOrQ.
12.	Llanos-Mendez A, Villegas P. Robot-assisted surgery using da Vinci robot telemanipulation in prostatectomy (Structured abstract). Available at: http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?AccessionNumber=32007000110#.Us-0hnDUOrQ.
13.	Balshem H, Helfand M, Schünemann H, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol, 2011, 64(4): 401-406.
14.	Guyatt GH, Oxman AD, Sultan S, et al. GRADE guidelines:9. Rating up the quality of evidence. J Clin Epidemiol, 2011, 64(12):1311-1316.
15.	Alasari S, Min BS. Robotic colorectal surgery:a systematic review. ISRN surgery, 2012, 2012:293894.
16.	Antoniou SA, Antoniou GA, Koch OO, et al. Robot-assisted laparoscopic surgery of the colon and rectum. Surg Endosc, 2012, 26(1): 1-11.
17.	Braga LHP, Pace K, DeMaria J, et al. Systematic Review and MetaAnalysis of Robotic-Assisted versus Conventional Laparoscopic Pyeloplasty for Patients with Ureteropelvic Junction Obstruction: Effect on Operative Time, Length of Hospital Stay, Postoperative Complications, and Success Rate. Eur Urol, 2009, 56(5):848-857.
18.	Carvalho L, Abrao MS, Deshpande A, et al. Robotics as a new surgical minimally invasive approach to treatment of endometriosis:a systematic review. Int J Med Robotics Comput Assist Surg, 2012, 8(2): 160-165.
19.	El-Hakim A, Leung RA, Tewari A. Robotic prostatectomy:a pooled analysis of published literature. Expert REV. Anticancer Ther, 2006, 6(1):11-20.
20.	Ficarra V, Cavalleri S, Novara G, et al. Evidence from robot-assisted laparoscopic radical prostatectomy:a systematic review. Eur Urol, 2007, 51(1):45-55.
21.	Gill RS, Al-Adra DP, Birch D, et al. Robotic-assisted bariatric surgery:a systematic review. Int J Med Robotics Comput Assist Surg, 2011, 7(3):249-255.
22.	Kanji A, Gill RS, Shi XZ, et al. Robotic-assisted colon and rectal surgery:a systematic review. Int J Med Robotics Comput Assist Surg, 2011, 7(4):401-407.
23.	Liu H, Lu D, Wang L, et al. Robotic surgery for benign gynaecological disease. Cochrane Database Syst Rev, 2012:CD008978.
24.	Memon S, Heriot AG, Murphy DG, et al. Robotic versus laparoscopic proctectomy for rectal cancer:a meta-analysis. Ann Surg Oncol, 2012, 19(7):2095-2101.
25.	Ortiz-Oshiro E, Sanchez-Egido I, Moreno-Sierra J, et al. Robotic assistance may reduce conversion to open in rectal carcinoma laparoscopic surgery:systematic review and meta-analysis. Int J Med Robotics Comput Assist Surg, 2012, 8(3):360-370.
26.	Wang Z, Zheng Q, Jin Z. Meta-analysis of robot-assisted versus conventional laparoscopic Nissen fundoplication for gastro-oesophageal reflux disease. ANZ J Surg, 2012, 82(3):112-117.
27.	Weinberg L, Rao S, Escobar PF. Robotic surgery in gynecology:an updated systematic review. Obstet Gynecol Int, 2011, 2011:852061.
28.	Yang Y, Wang F, Zhang P, et al. Robot-Assisted Versus Conventional Laparoscopic Surgery for Colorectal Disease, Focusing on Rectal Cancer:A Meta-analysis. Ann Surg Oncol, 2012, 19(12):3727-3736.

1. 嵇武, 李宁, 黎介寿.我国手术机器人外科面临的机遇和挑战.中国微创外科杂志, 2012, 12(7):577-579.
2. Da vinci changing the experience of Surgery. Intuitive Surgical. Available at: http://www.davincisurgery.com/.
3. Barbash GI, Glied SA. New Technology and Health Care Costs-The Case of Robot-Assisted Surgery. N Engl J Med, 2010, 363(8):701-704.
4. Steinberg PL, Merguerian PA, Bihrle W, et al. The cost of learning robotic-assisted prostatectomy. Urology, 2008, 72(5):1068-1072.
5. Health Information and Quality Authority. Health technology assessment of robot-assisted surgery in selected surgical procedures. Ireland. 2011. Available at: http://www.hiqa.ie/publications/healthtechnology-assessment-robot-assisted-surgery-selected-surgicalprocedures.
6. Tooher R, Pham C. Da Vinci surgical robotic system:technology overview (Structured abstract). HTA Database, 2004.
7. Tsakonas E, Nkansah E. The da Vinci surgical robotic system:a review of the clinical and cost-effectiveness (Structured abstract). Available at: http://www.crd.york.ac.uk/NIHR_CRDWEB/ShowRecord.asp?LinkFrom=OAI&ID=32011001301#.Us-zjnDUOrQ.
8. Chuong H, Eva T, Khai T, et al. Robot-assisted surgery versus open surgery and laparoscopic surgery:clinical and cost-effectiveness analyses (Project record). Available at: http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?LinkFrom=OAI&ID=32011000303#.UszxXDUOrQ.
9. Llanos-Mendez A, Villegas P. Robotic surgery using the da Vinci robotic telemanipulation system in hysterectomy (Structured abstract). Available at: http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?LinkFrom=OAI&ID=32011000513#.Us-zCHDUOrQ.
10. Llanos-Mendez A, Villegas P. Robotic surgery by means of the da Vinci robotic telemanipulation system in general and digestive surgery (Structured abstract). Available at: http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?LinkFrom=OAI&ID=32011000512#.Usz6XDUOrQ.
11. Llanos-Mendez A, Villegas P. Robotic surgery using the da Vinci robotic telemanipulation system in hysterectomy (Structured abstract). Available at: http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?LinkFrom=OAI&ID=32011000513#.Us-0OXDUOrQ.
12. Llanos-Mendez A, Villegas P. Robot-assisted surgery using da Vinci robot telemanipulation in prostatectomy (Structured abstract). Available at: http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?AccessionNumber=32007000110#.Us-0hnDUOrQ.
13. Balshem H, Helfand M, Schünemann H, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol, 2011, 64(4): 401-406.
14. Guyatt GH, Oxman AD, Sultan S, et al. GRADE guidelines:9. Rating up the quality of evidence. J Clin Epidemiol, 2011, 64(12):1311-1316.
15. Alasari S, Min BS. Robotic colorectal surgery:a systematic review. ISRN surgery, 2012, 2012:293894.
16. Antoniou SA, Antoniou GA, Koch OO, et al. Robot-assisted laparoscopic surgery of the colon and rectum. Surg Endosc, 2012, 26(1): 1-11.
17. Braga LHP, Pace K, DeMaria J, et al. Systematic Review and MetaAnalysis of Robotic-Assisted versus Conventional Laparoscopic Pyeloplasty for Patients with Ureteropelvic Junction Obstruction: Effect on Operative Time, Length of Hospital Stay, Postoperative Complications, and Success Rate. Eur Urol, 2009, 56(5):848-857.
18. Carvalho L, Abrao MS, Deshpande A, et al. Robotics as a new surgical minimally invasive approach to treatment of endometriosis:a systematic review. Int J Med Robotics Comput Assist Surg, 2012, 8(2): 160-165.
19. El-Hakim A, Leung RA, Tewari A. Robotic prostatectomy:a pooled analysis of published literature. Expert REV. Anticancer Ther, 2006, 6(1):11-20.
20. Ficarra V, Cavalleri S, Novara G, et al. Evidence from robot-assisted laparoscopic radical prostatectomy:a systematic review. Eur Urol, 2007, 51(1):45-55.
21. Gill RS, Al-Adra DP, Birch D, et al. Robotic-assisted bariatric surgery:a systematic review. Int J Med Robotics Comput Assist Surg, 2011, 7(3):249-255.
22. Kanji A, Gill RS, Shi XZ, et al. Robotic-assisted colon and rectal surgery:a systematic review. Int J Med Robotics Comput Assist Surg, 2011, 7(4):401-407.
23. Liu H, Lu D, Wang L, et al. Robotic surgery for benign gynaecological disease. Cochrane Database Syst Rev, 2012:CD008978.
24. Memon S, Heriot AG, Murphy DG, et al. Robotic versus laparoscopic proctectomy for rectal cancer:a meta-analysis. Ann Surg Oncol, 2012, 19(7):2095-2101.
25. Ortiz-Oshiro E, Sanchez-Egido I, Moreno-Sierra J, et al. Robotic assistance may reduce conversion to open in rectal carcinoma laparoscopic surgery:systematic review and meta-analysis. Int J Med Robotics Comput Assist Surg, 2012, 8(3):360-370.
26. Wang Z, Zheng Q, Jin Z. Meta-analysis of robot-assisted versus conventional laparoscopic Nissen fundoplication for gastro-oesophageal reflux disease. ANZ J Surg, 2012, 82(3):112-117.
27. Weinberg L, Rao S, Escobar PF. Robotic surgery in gynecology:an updated systematic review. Obstet Gynecol Int, 2011, 2011:852061.
28. Yang Y, Wang F, Zhang P, et al. Robot-Assisted Versus Conventional Laparoscopic Surgery for Colorectal Disease, Focusing on Rectal Cancer:A Meta-analysis. Ann Surg Oncol, 2012, 19(12):3727-3736.

Chinese Journal of Evidence-Based Medicine

Safety and Effectiveness of Da Vinci Surgical System: A Rapid Review^△

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Chinese Journal of Evidence-Based Medicine

Safety and Effectiveness of Da Vinci Surgical System: A Rapid Review△

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Safety and Effectiveness of Da Vinci Surgical System: A Rapid Review^△