The role of robotics in cardiac surgery: a systematic review

The application of robotic technologies in cardiac surgery has provided the possibility for minimally invasive access inside the thorax and avoidance of a median sternotomy. Given that current evidence seems promising, we sought to systematically review the existing literature regarding the efficacy, feasibility and mortality rate associated with robotic cardiac surgery. The PubMed and Cochrane bibliographical databases were thoroughly searched for the following MeSH terms: "robotic", "cardiac surgery" and "heart surgery". Original studies on robotic cardiac surgery in more than ten cases and reporting on the associated peri- or post-operative mortality were deemed eligible. Twenty-eight studies were included and provided data for 5993 patients with a mean age of 59.8 years. Approximately, one out of two patients (49.2%) underwent robotic CABG, while the other half (49.9%) underwent robotic MVR. Robotic atrial septal defect repair and atrial tumor resection were performed in a small proportion (0.9%) of the patients. Mean 30-day mortality was 0.7% ranging from 0 to 0.8% among the different types of surgery, while late mortality was 0.8% ranging from 0 to 1% with a mean follow-up period of 40.1 months. Our findings demonstrate that the application of robotics in cardiac surgery has provided a safe and efficacious alternative to the traditional techniques. However, more trials are necessary to elucidate all of its aspects.