Robot-assisted surgery is a minimally invasive procedure where instruments are controlled through a telemanipulator. This is intended to lead to higher dexterity compared to the human hand and the laparoscope, thus allowing for a higher level of precision. Robot-assisted procedures claim to enhance clinical outcomes and reduce healthcare resource utilisation when compared to open surgery or laparoscopy. The present report is an update of a systematic review from 2019, which investigated the effectiveness and safety of robot-assisted surgery compared to open surgery and conventional laparoscopy in thoracic and visceral indications.

For five out of the 14 procedures, no evidence could be identified. In total, 20 randomised controlled trials and five follow-up publications met the inclusion criteria. In most studies, relevant endpoints were either not reported, not measured, or did not show statistically significant differences. Regarding some endpoints (e.g. blood loss), robot-assisted procedures showed advantages, but these results were only shown by a few studies with low-quality evidence. As for the operation time, only conflicting results could be identified.

In general, robot-assisted surgery is associated with higher costs in terms of acquisition and maintenance compared to conventional procedures. Additionally, it is associated with an increased environmental impact due to higher greenhouse gas emissions and waste generation.

In conclusion, due to the heterogeneous results and the lack of evidence for a variety of study endpoints, a general statement about the effectiveness and safety of robot-assisted surgery is not possible. Furthermore, most of the extracted results did not support the claimed benefits of robot-assisted procedures.