Robotics in facial plastic surgery: a systematic review and meta-analysis of the latest trends and innovations

Robotic-assisted surgery is increasingly incorporated into facial plastic and reconstructive surgery (FPRS) procedures. However, the extent to which robotics improves operative performance or clinical outcomes in FPRS remains unclear. This systematic review and meta-analysis evaluates current applications of robotic-assisted FPRS.

A PRISMA-guided systematic search of PubMed/MEDLINE, Embase, Cochrane, Web of Science, and Google Scholar (January 2020-November 2025) identified clinical studies investigating robotic-assisted FPRS procedures. Data extracted included robotic platform used, surgical indication, operative time, personnel involvement, complications, and outcomes. A random-effects meta-analysis was performed for operative time when sufficient data were available.

Fourteen studies met the inclusion criteria. Seven robotic systems were used, most commonly the CARLO^® device and the da Vinci Xi system (n = 3, 21%, respectively). Robotic systems were used for craniomaxillofacial (n = 8, 57%), oculoplastic (n = 3, 21%), reconstructive microsurgical (n = 2, 14%), and otolaryngologic procedures (n = 1, 7%). More personnel were needed for robotic cases, frequently involving two surgeons. Five studies were eligible for meta-analysis. Robotic procedures showed a pooled mean operative time of 150.8 min versus 122.7 min for manual surgery, with a mean difference of + 20.3 min (95% CI -11.0 to 51.6). Procedure-specific differences varied widely: robotic distraction osteogenesis was faster, whereas robotic microvascular anastomosis, mandibular contouring, and maxillofacial reconstruction were slower. Complication rates were low overall.

Robotic-assisted FPRS appears feasible by offering improved precision but generally requires longer operative times. As robotic systems evolve, and workflows become standardized, broader clinical integration should be expected.