Objective To comprehensively analyze the cost-utility of robotic surgery in clinical practice and to investigate the reporting and methodological quality of the related evidence. Methods Data on cost-utility analyses (CUAs) of robotic surgery were collected in seven electronic databases from the inception to July 2021. The quality of the included studies was assessed using the CHEERs and QHES checklists. A systematic review was performed with the incremental cost-effectiveness ratio as the outcome of interest. Results Thirty-one CUAs of robotic surgery were eligible. Overall, the identified CUAs were fair to high quality, and 63% of the CUAs ranked the cost-utility of robotic surgery as “favored,” 32% categorized as “reject,” and the remaining 5% ranked as “unclear.” Although a high heterogeneity was present in terms of the study design among the included CUAs, most studies (81.25%) consistently found that robotic surgery was more cost-utility than open surgery for prostatectomy (ICER: $6905.31/QALY to $26240.75/QALY; time horizon: 10 years or lifetime), colectomy (dominated by robotic surgery; time horizon: 1 year), knee arthroplasty (ICER: $1134.22/QALY to $1232.27/QALY; time horizon: lifetime), gastrectomy (dominated by robotic surgery; time horizon: 1 year), spine surgery (ICER: $17707.27/QALY; time horizon: 1 year), and cystectomy (ICER: $3154.46/QALY; time horizon: 3 months). However, inconsistent evidence was found for the cost-utility of robotic surgery versus laparoscopic surgery and (chemo)radiotherapy. Conclusions Fair or high-quality evidence indicated that robotic surgery is more cost-utility than open surgery, while it remains inconclusive whether robotic surgery is more cost-utility than laparoscopic surgery and (chemo)radiotherapy. Thus, an additional evaluation is required.

PURPOSE: The purpose of this integrative literature review is to examine the evidence on factors affecting patient safety during robotic-assisted and laparoscopic surgeries. DESIGN: Systematic review of papers published between 2011 and 2016 that identified factors affecting safety during robotic-assisted and laparoscopic surgeries, in the areas of colorectal, general, urological, and gynecological surgeries. METHODS: A systematic literature search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and Medline databases were performed. Twelve studies met the inclusion criteria outlining factors affecting safety in robotic-assisted and laparoscopic surgeries. All 12 studies selected were quality appraised using the Critical Appraisal Skills Programme. FINDINGS: Using thematic analysis, the outcomes from the 12 studies were categorized into three thematic categories. Intraoperative communication, teamwork, and disruptions are the key factors affecting patient safety during robotic-assisted and laparoscopic surgeries. CONCLUSIONS: This integrative literature review identifies a dearth of evidence examining factors affecting patient safety during robotic-assisted and laparoscopic surgeries. It draws attention to the complexities with teamwork, intraoperative communication and disruptions during robotic-assisted and laparoscopic surgeries. Although robotic-assisted surgery is generally seen as safe and effective, this review highlights the need for education and training that focuses on non-technical skills development, disruption prevention and alertness in anticipating and minimising risk. CLINICAL RELEVANCE: The evidence from this review identifies the different demands and diverse challenges in maintaining safety during robotic-assisted and laparoscopic surgery. Although specific technical knowledge and skills are essential, this review highlights the importance of developing new ways of thinking with regard to assessment and management of disruptions, developing different teamwork patterns and communication skills, and overcoming challenges introduced during technology advanced surgeries. Nurses in the perioperative setting have an increased responsibility to continue professional development and remain vigilant to factors affecting patient safety. Early identification and management of factors leading to disruptions is imperative in the provision of safe perioperative care.