Research On The Quality Of Evidence For The Application Of Da Vinci Robot In The Surgical Field Based On The GRADE Approach

Objective To rate the quality of evidence in da Vince robotic surgery and investigate the distribution of different level evidence in different surgical field.Method We systematically searched PubMed,EMBASE,Cochrane library,and Web of science up to January 21,2017,to identify all meta-analyses(MRs)for robotic surgery.GRADE was used to interpret the major outcomes of MRs and investigate the distribution of downgraded factors in the surgical field.Result A total 74 MRs including 306 main outcomes were identified eventually.We found evidence quality of main outcomes in the surgical field was moderate quality accounted for 9.48%(29),low quality accounted for 45.75%(140),and very low quality accounted for 44.77%(137).In addition,MRs that were the highest quality evidence and the larger population distributed in field of gastrointestinal surgery under four main outcomes(operative time,blood loss,LOS,and harvested lymph nodes)except complications.Compared RS with LS/VS or OS,there was a trend that RG was associated with a longer operative time,a higher number of harvested lymph nodes,a shorter LOS and low rate of complication in most surgical fields.The major downgrading factors were risk of bias and inconsistency,respectively accounting for 39.42% and 26.52%.Conclusion Based on current research,the overall quality of evidence of RS in the surgical field was poor,and whether it could bring a potential benefit for patients remained unclear.None of high quality evidence was found in all surgical realm.Compared with other surgical fields,the level of evidence quality was higher in gastrointestinal surgery.In addition,most of outcomes reported by meta analyses were at risk of bias,dramatic heterogeneity and so on.Therefore,the high quality clinic trials,especially large sample size multicenter RCTs,was warrant on this topic in the future.