Comparative outcomes of robotic surgery <i>vs</i> conventional sternotomy for cardiac myxoma excision: A meta-analysis

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 &lt; 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.