Perioperative outcomes of robotic-assisted versus traditional surgery for DIEP flap breast reconstruction: a systematic review and meta-analysis.

backgroundBreast cancer has the highest incidence among female malignancies, and surgical intervention remains a cornerstone of its management. However, destructive procedures such as traditional mastectomy or breast-conserving surgery can significantly alter patients' physical appearance and self-perception, thereby compromising their quality of life. Robotic technology has enabled new directions for minimal invasive breast surgery. The purpose of this analysis is to investigate differences in complication rates between robotic assisted DIEP flap breast reconstruction and conventional DIEP flap breast reconstruction.

methodsA comprehensive literature scan on PubMed, Web of Science, Embase, and The Cochrane Library was performed for clinical studies, specifically for comparative clinical studies (including RCTs if available), on robotic assisted DIEP flap breast reconstruction, compared with conventional DIEP flap breast reconstruction. Primary outcome measures included complete flap loss, delayed wound healing, donor-site seroma, hematoma, and infection. Secondary outcomes encompassed operative duration, postoperative hospital stay, and patient-reported aesthetic scores. For categorical variables, odds ratios (OR) were used, while for continuous variables, mean differences (MD), were employed, with 95% confidence intervals (CI) for both.

resultsA total of five studies with 691 participants were employed. No significant differences were found in major complication rates, such as complete flap loss, healing delay, seroma, hematoma, or infection, between groups. Compared with the conventional group, there were significantly longer operative times in the robotic group (MD = 62.82, 95% CI [37.75, 87.90], P < 0.001) while hospital stays were significantly shorter in the robotic group (MD = -0.61, 95% CI [-1.03, -0.20], P = 0.003).

conclusionsHarvesting DIEP flaps with robotic assistance is safe and feasible. Its clinical application is associated with reduced hospitalization duration and increased operative time. This approach demonstrates potential for improving aesthetic outcomes and patient satisfaction, positioning it as a promising surgical option in clinical practice. Nevertheless, long-term follow-ups are needed to reaffirm its safety and efficacy in oncological practice.