Robotic-assisted versus conventional median sternotomy for the surgical excision of cardiac myxomas: a systematic review and meta-analysis

Abstract

Background: Cardiac myxoma constitutes the most prevalent primary heart tumour, often necessitating surgical resection to prevent complications. While median sternotomy is the standard approach, it is associated with significant morbidity. Robotic-assisted myxoma excision (RA-ME) has emerged as a minimally invasive alternative, but comparative data on their outcomes remain limited. Our meta-analysis aimed to compare postoperative outcomes of RA-ME versus conventional median sternotomy myxoma excision (MS-ME). Methods: We systematically searched MEDLINE, Scopus, and Cochrane Library, focusing on studies that compared RA-ME and MS-ME. Pooled odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using RevMan 8.13.0. Results: Seven studies comprising 447 patients, with 180 (40.3%) undergoing RA-ME, were included. RA-ME was associated with significantly longer cardiopulmonary bypass times [MD 23.0 min; 95% CI 11.1 to 35.00; p = 0.0001] and aortic cross-clamp times [MD 11.4 min; 95% CI 4.6 to 18.2; p = 0.001]. However, it demonstrated reduced hospital stay [MD − 2.00 days; 95% CI − 2.6 to − 1.4; p < 0.001], ICU stay [MD − 0.3 days; 95% CI − 0.5 to − 0.01; p = 0.04], blood loss [MD − 115.2 mL; 95% CI − 230.4 to − 0.02; p = 0.05], and blood transfusion requirements [OR 0.4; 95% CI 0.2 to 0.8; p = 0.01]. Other outcomes, including mechanical ventilation time, surgical re-exploration, arrhythmias, pneumonia, and surgical wound infections, were comparable. Conclusions: RA-ME may be a safe and effective alternative to MS-ME, offering improved recovery metrics with no compromise in safety despite longer operative times. However, high-quality prospective trials are needed for further validation. Trial registration: PROSPERO CRD42025633712.