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.