Reliability of the da Vinci robotic surgical system: a systematic review and pooled analysis of technical failures

Millions of patients undergo robot-assisted surgery. This technology carries potential risks to perioperative safety. Despite the widespread adoption of robotic platforms, data on the frequency of system malfunctions remain limited. We systematically reviewed and pooled data on the da Vinci robotic system malfunctions, providing a comprehensive analysis of failure rates and their procedural impact.

A systematic literature search was conducted using PubMed/Medline, Embase, Web of Science, and Scopus to identify studies published up to November 2024. PRISMA guidelines were followed for study selection. Primary outcome was the overall malfunction rate. Secondary outcomes included the proportion of device related (console or patient cart) and robotic instruments related failures, the procedural conversion rate due to robotic malfunction, and the incidence of injuries directly attributable to failures.

Twenty-five studies were included. Data from 3,308,134 procedures were reviewed. The pooled malfunction rate was 1.0% (95% CI: 0.9-1.2%). The pooled rate of device malfunctions was 0.1% (95% CI: 0.1%-0.1%); instrument malfunctions accounted for 0.4% (95% CI: 0.3-0.5%). The overall malfunction-related conversion rate was 0.09% (95%CI: 0.06-0.11%), with conversion to open and laparoscopic surgery in 0.1% and 0.04% of the total procedures, respectively. The pooled rate of malfunction-related injuries was 0.01% (95% CI: 0.01-0.02%), with no significant impact on patient outcomes.

These findings confirm the da Vinci system's overall reliability. Instrument malfunctions are most common but rare, with minimal need for surgical conversion. Injuries are uncommon. The study offers a benchmark for evaluating new robotic platforms.