title: Limited Evidence for Robot-assisted Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
abstract: OBJECTIVE
  To evaluate available evidence on robot-assisted surgery compared with open and laparoscopic surgery.
  
  
  METHODS
  The databases Medline, Embase, and Cochrane Library were systematically searched for randomized controlled trials comparing robot-assisted surgery with open and laparoscopic surgery regardless of surgical procedure. Meta-analyses were performed on each outcome with appropriate data material available. Cochrane Collaboration's tool for assessing risk of bias was used to evaluate risk of bias on a study level. The GRADE approach was used to evaluate the quality of evidence of the meta-analyses.
  
  
  RESULTS
  This review included 20 studies comprising 981 patients. The meta-analyses found no significant differences between robot-assisted and laparoscopic surgery regarding blood loss, complication rates, and hospital stay. A significantly longer operative time was found for robot-assisted surgery. Open versus robot-assisted surgery was investigated in 3 studies. A lower blood loss and a longer operative time were found after robot-assisted surgery. No other difference was detected.
  
  
  CONCLUSIONS
  At this point there is not enough evidence to support the significantly higher costs with the implementation of robot-assisted surgery.
authors.affiliation: Department of Surgery, Center for Perioperative Optimization, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
authors.forename: Malene
authors.initials: M
authors.lastname: Broholm
authors.forename: Iben
authors.initials: I
authors.lastname: Onsberg Hansen
authors.forename: Jacob
authors.initials: J
authors.lastname: Rosenberg
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D061646:Operative Time; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D012371:Robotics / Q000379:methods*