Robotic surgery in gastrointestinal emergency settings: A systematic review

Table 1 Quality assessment for the selected retrospective cohort studies according to the Newcastle Ottawa Scale

Ref.	Selection	Comparability	Outcome	Total score	Quality threshold
Choi et al[18]	+++	+	++	6	Moderate
Kubat et al[22]	+++	+	+++	7	High
Choudhry et al[19]	++++	++	+++	9	High
Robinson et al[28]	+++	+	++	6	Moderate
Yi et al[27]	+++	+	++	6	Moderate
Rifai et al[24]	++++	+	+++	8	High
Becker et al[29]	+++	+	+++	7	High
Kudsi et al[37]	+++	+	+++	7	High
Campbell et al[17]	++++	++	+++	9	High
Bou-Ayash et al[36]	+++	+	++	6	Moderate
Latif et al[25]	+++	+	+++	7	High
Hosein et al[41]	++++	+	+++	8	High
Sanderfer et al[2]	++++	+	+++	8	High
Anderson et al[30]	+++	+	++	6	Moderate
Kudsi et al[35]	+++	+	+++	7	High
Arnott et al[31]	+++	+	++	6	Moderate
Kaoukabani et al[21]	+++	+	+++	7	High
Grimsley et al[20]	++++	++	+++	9	High
Iaquinandi et al[43]	+++	++	++	6	Moderate
Shen et al[26]	+++	+	+++	7	High
Klein et al[12]	++++	+	+++	8	High
Murgante Testa et al[38]	+++	+	++	6	Moderate

Table 2 Quality assessment for the selected case series/case reports

Ref.	Selection	Ascertainment	Causality	Reporting	Overall score
Pedraza et al[34]	+	++	++	+	6/8
Smith et al[46]	+	++	+	+	5/8
Felli et al[33]	+	++	++	+	6/8
Milone et al[23]	+	++	++	+	6/8
Ceccarelli et al[40]	+	++	++	+	6/8
Cubas et al[44]	+	++	++	+	6/8
Maertens et al[32]	+	++	++	+	6/8
Shchatsko et al[39]	+	++	++	+	6/8
Conticchio et al[45]	+	++	+	+	5/8
Jambhekar et al[42]	+	++	++	+	6/8

Table 3 Characteristics of the included studies in the systematic review

Ref.	Study design	Country	Aim of the study	Robot type	Indication	Procedure performed	Number of patients
Felli et al[33]	Case report	Italy	Description, feasibility	Da Vinci system	Bleeding neoplasm	Right hemicolectomy	1
Cubas et al[44]	Case report	United States	Description, feasibility and safety	Da Vinci Xi system	Incarcerated morgagni hernia	Mesh hernia repair	1
Ceccarelli et al[13]	Case series	Italy	Feasibility and safety	Da Vinci Xi system	Hiatal hernias	Direct or mesh repair with Nissen/Toupet	3
Maertens et al[32]	Case series	United Kingdom	Patient outcomes	Da Vinci Xi system	Gastrointestinal emergency	Colectomy, Hartmann’s procedure	10
Shchatsko et al[39]	Case report	United States	Feasibility and safety	Da Vinci system	Abdominal wall penetrating trauma	Direct primary repair	1
Milone et al[23]	Case report	Italy	Description, feasibility and safety	Da Vinci system	Acute cholecystitis	Cholecystectomy	3
Pedraza et al[34]	Case report	United States	Description, feasibility and safety	Da Vinci system	Iatrogenic sigmoid perforation	Primary repair	1
Conticchio et al[45]	Case report	Italy	Description, feasibility and safety	Not specified	Ruptured hepatocellular carcinoma	Resection of segment 3	1
Yi et al[27]	Retrospective cohort study	China	Safety and effectiveness	Micro Hand S	Gastrointestinal and gallbladder emergency	Direct ulcer repair, appendectomy, cholecystectomy, colectomy	10
Jambhekar et al[42]	Case report	United States	Description, feasibility and safety	Da Vinci system	Bochdalek hernia	Direct diaphragmatic repair	1
Smith et al[46]	Case report	United States	Description, feasibility and safety	NR	Gallstone ileus	Enterotomy	1
Becker et al[29]	Retrospective cohort study	United States	Comparison of postoperative outcomes	NR	Acute appendicitis	Appendectomy	50
Kudsi et al[37]	Retrospective cohort study	United States	Comparison of postoperative outcomes	NR	Ventral hernia	Mesh and direct repair	35
Rifai et al[24]	Retrospective cohort study	United States	Evaluation of operative time and post-operative length of stay	NR	Acute cholecystitis and acute appendicitis	Appendectomy and cholecystectomy	246
Campbell et al[17]	Retrospective cohort study	United States	Comparison of post-operative outcomes	NR	Acute cholecystitis, biliary pancreatitis, CBD stones and cholangitis	Cholecystectomy	10019
Choi et al[18]	Retrospective cohort study	Vietnam	Comparison of outcomes of different robotic systems	Si, Xi, SP da Vinci system	Acute cholecystitis	Cholecystectomy	300
Bou-Ayash et al[36]	Retrospective cohort study	United States	Clinical outcomes	Da Vinci system	Incarcerated inguinal hernias	TAPP repair	19
Latif et al[25]	Retrospective cohort study	United Kingdom	Clinical outcomes	Da Vinci X system	Acute cholecystitis	Cholecystectomy, CBD exploration	23
Kubat et al[22]	Retrospective cohort study	United States	Clinical outcomes	Da Vinci Si system	Acute cholecystitis	Cholecystectomy	74
Hosein et al[41]	Retrospective cohort study	United States	Feasibility and safety	NR	Hiatal hernia	Hiatal hernia repair	131
Robinson et al[28]	Retrospective cohort study	United States	Feasibility and safety	Da Vinci Si and Xi system	Perforated peptic ulcers	Direct repair	24
Sanderfer et al[2]	Retrospective cohort study	United States	Description, feasibility and safety	NR	Appendicitis, acute cholecystitis, incarcerated inguinal hernia, colon bleeding, acute diverticulitis, complicated ventral hernia	Appendectomy, cholecystectomy, inguinal hernia repair, colectomy, ventral hernia repair	133
Anderson et al[30]	Retrospective cohort study	United States	Description, feasibility and safety	Da Vinci Xi system	Acute ulcerative colitis	Subtotal colectomy	6
Kudsi et al[35]	Retrospective cohort study	United States	Feasibility	Da Vinci system	Incarcerated ventral/incisional hernia	IPOM, TAPP, Rives-Stoppa, TAR	34
Arnott et al[31]	Retrospective cohort study	United States	Evaluation of short-term outcomes	NR	Acute complicated diverticulitis	Left hemicolectomy	20
Kaoukabani et al[21]	Retrospective cohort study	United States	Outcomes in the elderly	NR	Acute cholecystitis	Cholecystectomy	157
Grimsley et al[20]	Retrospective cohort study	United States	Outcomes and hospital costs	NR	Acute appendicitis, acute cholecystitis, complicated inguinal hernia	Appendectomy, cholecystectomy, inguinal hernia repair	2747
Choudhry et al[19]	Retrospective cohort study	United States	Description, feasibility and safety	Da Vinci Xi system	Acute cholecystitis	Cholecystectomy	135
Iaquinandi et al[43]	Retrospective cohort study	Switzerland	Safety and feasibility	NR	Para-esophageal hernias	Repair of para-esophageal hernias	17
Shen et al[26]	Retrospective cohort study	United States	To assess safety and feasibility	Da Vinci Xi system	Acute cholecystitis	Cholecystectomy	62
Klein et al[12]	Retrospective cohort study	United States	Safety and feasibility	NR	Acute cholecystitis	Cholecystectomy	130
Murgante Testa et al[38]	Retrospective cohort study	Switzerland	Feasibility and safety	NR	Incarcerated inguinal hernia	TAPP repair	15

NR: Not reported; CBD: Common biliary duct; IPOM: Intra-peritoneal onlay mesh; TAPP: Trans-abdominal pre-peritoneal; TAR: Transverus abdominis release.

Table 4 Pooled clinical outcomes by surgical indication

Indication	Number of patients	Ref.	Pooled mean operative time (minute)	Pooled mean LOS (days)	Documented conversion rate (sub-cohort)	Dominant identified platform
Acute cholecystitis	13242	[2,12,17-27]	126.1	3.3	0.6%	da Vinci Xi
Perforated peptic ulcer	25	[27,28]	87.4	4.9	0.0%	da Vinci Xi
Acute appendicitis	475	[2,20,24,27,29]	74.5	2.2	0.0%[24]	NR
Colorectal procedures	326	[2,30-34]	238.4	6.0	11.4%	NR
Abdominal wall (hernia)	138	[2,35-38]	123.5	2.6	NR	NR
Abdominal trauma	1	[39]	NR	NR	0.0%	da Vinci
Other applications	26	[40-45]	177.8	7.0	0.0%	NR

NR: Not reported; LOS: Length of stay.