Computer-assisted surgery using telemanipulators: an evidence-based analysis.
OBJECTIVE
The objective of this health technology policy assessment was to determine the effectiveness and cost-effectiveness of computer-assisted surgery with telemanipulators.


METHODS
The technology for computer-assisted surgery with telemanipulators is a robotic arm that carries an endoscope while two other manipulator arms carry interchangeable tools, such as scissors and grippers. In a master-slave telemanipulator system, the master may consist of a joystick input system, or for surgery, may mimic the motion of the slave robot, such as the da Vinci and ZEUS surgical systems. These systems are capable of telerobotic surgery, or surgery from remote locations.


METHODS
The Cochrane and INAHTA databases yielded 4 health technology assessments or systematic reviews on computer-assisted surgery using telemanipulators. A search of MEDLINE and EMBASE January 1, 2001 to November 24, 2003 was conducted. This search produced 448 studies, of which 19 met the inclusion criteria.


RESULTS
Published health technology assessments indicate that there are limited data from studies, although there is initial evidence of the safety and efficacy of telemanipulators in some procedures when they are used at large academic centres for surgery on selected patients. Most studies are Level 3 and 4 observational studies and assess a wide variety of surgical procedures. Limited studies indicate the promise of telemanipulators, but their efficacy is not fully established. In some procedures, the advantages that telemanipulators may offer may also be achieved by non-robotic minimally invasive/laparoscopic techniques. To date, cost-effectiveness has not been demonstrated. Patients who have undergone robotic surgery must be followed to further define outcomes (e.g., long-term quality of the graft after coronary arterial bypass graft [CABG] surgery). The exact role of computer-assisted surgery with telemanipulators has not been fully defined. Telemanipulators should be used in procedures for which their performance offers the greatest advantage over non-computer-enhanced surgical procedures.