Robotic versus manual diagnostic and stenting procedures: a systematic review and meta-analysis.

Objective: Endovascular procedures are associated with improved outcomes and patient satisfaction compared to open surgery in selected cases. However, this is at the cost of increased radiation exposure. Robotic procedures are thought to minimize radiation exposure and may confer procedural efficacy due to the lack of operator fatigue. Our systematic review and meta-analysis compares procedural efficacy of robotic versus manual diagnostic and stenting procedures.

Methods: PubMed, Embase and Scopus were searched in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Articles reporting comparative outcomes between robotic and manual diagnostic and stenting procedures were included. Articles related to stereotactic radiosurgery and open surgical procedures were excluded. The Newcastle Ottawa Scale was used to assess risk of bias. Effect sizes (mean difference for robotic and manual procedures) and variances were calculated for procedure time. The random effects model was used to calculate pooled estimates for technical success using the "metafor" package in R (R software v4.2.1, Vienna, Austria).

Results: 6465 articles were identified through our search strategy. After 4683 articles were excluded through a title and abstract screen and 30 articles were excluded through a full text review, 3 articles reporting outcomes in 175 patients undergoing robotic procedures and 185 patients undergoing manual procedures were included. These studies reported comparative outcomes for carotid artery stenting, diagnostic cerebral angiograms and transverse sinus stenting. There was no significant difference in procedure time (mean difference: 0.14 min [95% confidence interval (CI): -0.58, 0.86, p = 0.64, I² = 68%]. Technical success was 0.05-fold lower for robotic procedures compared to manual procedures [95% CI: 0.00- 0.84), P = 0.04]. One study was considered high quality using the NOS.

Conclusions: Robotic procedures confer significantly lower rates of technical success with no significant difference in procedure time. Further studies are necessary to draw conclusions about potential benefits of robotic procedures including lower radiation exposure.