Meta-Analysis
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Aug 26, 2025; 17(8): 111159
Published online Aug 26, 2025. doi: 10.4330/wjc.v17.i8.111159
Comparative outcomes of robotic surgery vs conventional sternotomy for cardiac myxoma excision: A meta-analysis
Mirza Muhammad Hadeed Khawar, Hooria Ejaz, Muhammad Soban Jaffar, Muhammad Kashif, Mavia Habib, Absar Mukhtar, Hafsa Riaz, Syed Abdullah Shah, Awon Muhammad, Umad Ali, Hannan Saeed, Muhammad Khan Buhadur Ali, Rejina Chhetri
Mirza Muhammad Hadeed Khawar, Hooria Ejaz, Muhammad Soban Jaffar, Muhammad Kashif, Mavia Habib, Absar Mukhtar, Hafsa Riaz, Department of Cardiology, Services Institute of Medical Sciences, Lahore 40050, Punjab, Pakistan
Syed Abdullah Shah, Awon Muhammad, Umad Ali, Hannan Saeed, Muhammad Khan Buhadur Ali, Department of Cardiology, King Edward Medical University, Lahore 54000, Punjab, Pakistan
Rejina Chhetri, Department of Cardiology, Nepalgunj Medical College, Kohal 21900, Nepal
Co-first authors: Mirza Muhammad Hadeed Khawar and Hooria Ejaz.
Author contributions: Khawar MMH and Ejaz H contribute equally to this study as co-first authors; Khawar MMH designed the research study, performed the research, analyzed the data, wrote the manuscript, and supervised the project; Ejaz H performed the research and analyzed the data; Jaffar MS performed the research and analyzed the data; Kashif M performed the research; Habib M performed the research; Mukhtar A performed the research; Riaz H performed the research; Shah SA performed the research; Muhammad A performed the research; Ali U analyzed the data; Saeed H performed the research; Buhadur Ali MK performed the research; Chhetri R performed the research; all authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors disclose that they have no conflict of interest related to the subject of this study.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rejina Chhetri, MD, Department of Cardiology, Nepalgunj Medical College, Chisapani Banke Baijanath 1 Chisapani, Kohal 21900, Nepal. rejinachhetri01@gmail.com
Received: June 24, 2025
Revised: July 2, 2025
Accepted: August 5, 2025
Published online: August 26, 2025
Processing time: 58 Days and 7.7 Hours
Abstract
BACKGROUND

Cardiac myxoma, a benign intracardiac tumor, is traditionally excised via conventional sternotomy, which is invasive and associated with longer recovery times. Minimally invasive robotic surgery has emerged as a potential alternative, offering reduced trauma and faster recovery. This meta-analysis compares the efficacy and safety of robotic surgery vs conventional sternotomy for cardiac myxoma excision. We hypothesized that robotic surgery would provide comparable safety outcomes with improved postoperative recovery, such as shorter hospital stays and reduced transfusion rates, despite potentially longer operative times.

AIM

To assess robotic surgery vs sternotomy for cardiac myxoma regarding operative times, hospital stay, transfusions, and complications.

METHODS

A systematic review was performed using EMBASE, OVID, Scopus, PubMed, Cochrane, and ScienceDirect databases to identify studies comparing robotic surgery and sternotomy for cardiac myxoma excision. Continuous outcomes were analyzed using mean differences (MDs), and categorical outcomes with odds ratios (ORs) and 95% confidence intervals (95%CIs). A random-effects model was used to pool data, accounting for study heterogeneity.

RESULTS

Six studies involving 425 patients (180 robotic, 245 conventional) were included. Robotic surgery significantly increased cross-clamp time (MD = 12.03 minutes, 95%CI: 2.14-21.92, P = 0.02) and cardiopulmonary bypass time (MD = 28.37 minutes, 95%CI: 11.85-44.89, P = 0.001). It reduced hospital stay (MD = -1.86 days, 95%CI: -2.45 to -1.27,P < 0.00001) and blood transfusion requirements (OR = 0.30, 95%CI: 0.13-0.69, P = 0.007). No significant differences were observed in atrial arrhythmia (OR = 0.55, 95%CI: 0.27-1.12) or ventilation time (MD = -1.72 hours, 95%CI: -5.27 to 1.83, P = 0.34).

CONCLUSION

Robotic surgery for cardiac myxoma excision prolongs operative times but shortens hospital stays and reduces transfusion needs, suggesting enhanced recovery without compromising safety.

Keywords: Robotic surgery; Cardiac myxoma; Sternotomy; Meta-analysis; Operative time; Hospital stay; Blood transfusion; Postoperative complications

Core Tip: This meta-analysis compares robotic surgery to conventional sternotomy for cardiac myxoma excision, revealing that robotic surgery, using systems like the da Vinci surgical system, significantly reduces hospital stay by 1.86 days and blood transfusion needs (odds ratio = 0.30). Despite longer cardiopulmonary bypass and cross-clamp times, robotic surgery enhances recovery without increasing complications like atrial arrhythmia. These findings highlight robotic surgery’s potential as a minimally invasive alternative, offering improved outcomes for suitable patients.