The use of robotics in otolaryngology-head and neck surgery: a systematic review.

BACKGROUND: Robotic surgery has become increasingly used due to its enhancement of visualization, precision, and articulation. It eliminates many of the problems encountered with conventional minimally invasive techniques and has been shown to result in reduced blood loss and complications. The rise in endoscopic procedures in otolaryngology-head and neck surgery, and associated difficulties, suggests that robotic surgery may have a role to play.

OBJECTIVE OF REVIEW: To determine whether robotic surgery conveys any benefits compared to conventional minimally invasive approaches, specifically looking at precision, operative time, and visualization.

TYPE OF REVIEW: A systematic review of the literature with a defined search strategy.

SEARCH STRATEGY: Searches of MEDLINE, EMBASE and CENTRAL using strategy: ((robot* OR (robot*AND surgery)) AND (ent OR otolaryngology)) to November 2010.

EVALUATION METHOD: Articles reviewed by authors and data compiled in tables for analysis.

RESULTS: There were 33 references included in the study. Access and visualization were regularly mentioned as key benefits, though no objective data has been recorded in any study. Once initial setup difficulties were overcome, operative time was shown to decrease with robotic surgery, except in one controlled series of thyroid surgeries. Precision was also highlighted as an advantage, particularly in otological and skull base surgery. Postoperative outcomes were considered equivalent to or better than conventional surgery. Cost was the biggest drawback.

CONCLUSIONS: The evidence base to date suggests there are benefits to robotic surgery in OHNS, particularly with regards to access, precision, and operative time but there is a lack of controlled, prospective studies with objective outcome measures. In addition, economic feasibility studies must be carried out before a robotic OHNS service is established.