Operator radiation burden and periprocedural outcomes in robotic-assisted versus manual percutaneous coronary intervention: a meta-analysis

BACKGROUND: Robotic-assisted percutaneous coronary intervention (rPCI) was introduced in part to reduce occupational radiation exposure and improve ergonomics in the catheterization laboratory, while also offering potential procedural advantages. However, the comparative clinical value of rPCI versus manual PCI (mPCI) remains uncertain. This meta-analysis aimed to evaluate the relative effects of rPCI and mPCI on postprocedural outcomes, healthcare personnel radiation exposure, postprocedural complications, and follow-up outcomes. METHODS: A systematic search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library to identify eligible studies published from January 2014 to January 2026. After rigorous study selection, data extraction, and methodological quality assessment, quantitative synthesis was performed using RevMan 5.4. Odds ratios (ORs) were used for dichotomous outcomes and mean differences (MDs) for continuous outcomes. A random-effects model was applied when heterogeneity was significant (I²>50%); otherwise, a fixed-effects model was used. RESULTS: Compared with mPCI, rPCI was associated with a consistent reduction in operator radiation exposure. Patient- and procedure-related radiation indices, including dose-area product, air kerma, and fluoroscopy time, also tended to favor rPCI. Procedural duration was longer with rPCI, whereas contrast use was comparable between groups. rPCI was also associated with higher clinical success and postprocedural TIMI 3 flow, while technical success and coronary dissection rates were similar between groups. At 12-month follow-up, rPCI showed a trend toward lower rates of major adverse cardiovascular events and all-cause mortality. CONCLUSIONS: The available data support a clear occupational safety advantage of rPCI and suggest favorable periprocedural safety and efficacy profiles, with potential clinical benefits. However, these findings, particularly for patient-level outcomes, should be considered hypothesis-generating rather than conclusive, as they are primarily derived from observational studies with limited sample sizes and require confirmation in larger randomized trials.