Perioperative neurocognitive outcomes after robot-assisted pelvic surgery: a systematic review and meta-analysis of reported proportions, comparative risk and prognostic factors.
5 affiliations
- 1Faculty of Medicine, Urology Department, Institute of Medical Sciences, Collegium Medicum, Cardinal Stefan Wyszyński University in Warsaw, Bursztynowa 2, Warsaw, 04-749, Poland. [email protected].
- 2Department of Urology and Urological Oncology, Multidisciplinary Hospital in Warsaw-Międzylesie, Bursztynowa 2, Warsaw, 04-749, Poland. [email protected].
- 3Affiliate Member, Robotics in Urology Working Group, Young Academic Urologists, European Association of Urology, Mr. E.N. van Kleffensstraat 5, Arnhem, 6842 CV, The Netherlands. [email protected].
- 4Department of Urology and Urological Oncology, Multidisciplinary Hospital in Warsaw-Międzylesie, Bursztynowa 2, Warsaw, 04-749, Poland.
- 5Faculty of Medicine, Urology Department, Institute of Medical Sciences, Collegium Medicum, Cardinal Stefan Wyszyński University in Warsaw, Bursztynowa 2, Warsaw, 04-749, Poland.
Abstract
Delirium and cognitive decline may complicate recovery after robot-assisted pelvic surgery, but their frequency and relationship to positioning remain uncertain. We assessed reported proportions, comparative surgical risk and prognostic factors. PubMed, CENTRAL, Scopus, Web of Science, Google Scholar, ClinicalTrials.gov and WHO ICTRP were searched through 4 August 2026. Eligible adult robotic pelvic studies reported objective cognitive testing or delirium. Two reviewers performed original screening, extraction and question-specific bias appraisal. Post hoc logit random-effects meta-analyses summarized prospective cohorts using restricted maximum likelihood and modified Hartung-Knapp intervals in R. Twenty-six reports represented 25 studies. Five cognitive cohorts (356 participants) yielded 29.0% (95% confidence interval [CI] 20.2-39.8%); excluding Beck yielded 31.8% (20.7-45.4%). Three delirium cohorts (245 participants) yielded a descriptive model summary of 10.3% (2.2-37.0%). Individual delirium proportions were 8/82 (9.8%; exact 95% CI 4.3-18.3%), 4/80 (5.0%; 1.4-12.3%) and 14/83 (16.9%; 9.5-26.7%). The approximate 95% prediction interval from the delirium meta-analysis was very wide (<0.1-99.8%). The same-procedure prostatectomy comparison yielded an unadjusted risk ratio of 1.06 (0.73-1.55) for early cognitive decline. Comparative evidence was of low or very low certainty. Definitions, surveillance and selection limited interpretation; Trendelenburg-duration findings were inconsistent. These proportions describe selected study-defined outcomes. They do not establish attributable robotic or positioning risk, a safe exposure threshold, or benefit from horizontal breaks. Standardized prospective measurement is needed.
Related
- Circulating and cerebrospinal fluid soluble TREM2 levels and risk of perioperative neurocognitive disorders in surgical patients: a systematic review and meta-analysis
- Perioperative neurocognitive disorders in elderly orthopedic surgery: from mechanistic insights to risk prediction and multimodal integrated care
- Comparative perioperative and oncological outcomes of the da Vinci Xi versus Si robotic surgical systems in rectal cancer surgery: a systematic review and meta-analysis.
- Neurocognitive Performance and Peripheral microRNA Expression in Schizophrenia and Obsessive-Compulsive Disorder: A Comparative Study
- Transcutaneous auricular vagus nerve stimulation in perioperative neurocognitive disorders: clinical evidence and mechanistic perspectives
BibTeX
@article{drobot2026perioperative,
title = {{Perioperative neurocognitive outcomes after robot-assisted pelvic surgery: a systematic review and meta-analysis of reported proportions, comparative risk and prognostic factors.}},
author = {Rafał Bogdan Drobot and Jędrzej Jakub Skorupka and Marcin Lipa},
journal = {Journal of robotic surgery},
year = {2026},
month = nov,
doi = {10.1007/s11701-026-04183-x},
url = {https://europepmc.org/article/MED/43009612},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Perioperative neurocognitive outcomes after robot-assisted pelvic surgery: a systematic review and meta-analysis of reported proportions, comparative risk and prognostic factors.
AU - Rafał Bogdan Drobot
AU - Jędrzej Jakub Skorupka
AU - Marcin Lipa
PY - 2026
DA - 2026/11/11
JO - Journal of robotic surgery
DO - 10.1007/s11701-026-04183-x
UR - https://europepmc.org/article/MED/43009612
AB - Delirium and cognitive decline may complicate recovery after robot-assisted pelvic surgery, but their frequency and relationship to positioning remain uncertain. We assessed reported proportions, comparative surgical risk and prognostic factors. PubMed, CENTRAL, Scopus, Web of Science, Google Scholar, ClinicalTrials.gov and WHO ICTRP were searched through 4 August 2026. Eligible adult robotic pelvic studies reported objective cognitive testing or delirium. Two reviewers performed original screening, extraction and question-specific bias appraisal. Post hoc logit random-effects meta-analyses summarized prospective cohorts using restricted maximum likelihood and modified Hartung-Knapp intervals in R. Twenty-six reports represented 25 studies. Five cognitive cohorts (356 participants) yielded 29.0% (95% confidence interval [CI] 20.2-39.8%); excluding Beck yielded 31.8% (20.7-45.4%). Three delirium cohorts (245 participants) yielded a descriptive model summary of 10.3% (2.2-37.0%). Individual delirium proportions were 8/82 (9.8%; exact 95% CI 4.3-18.3%), 4/80 (5.0%; 1.4-12.3%) and 14/83 (16.9%; 9.5-26.7%). The approximate 95% prediction interval from the delirium meta-analysis was very wide (<0.1-99.8%). The same-procedure prostatectomy comparison yielded an unadjusted risk ratio of 1.06 (0.73-1.55) for early cognitive decline. Comparative evidence was of low or very low certainty. Definitions, surveillance and selection limited interpretation; Trendelenburg-duration findings were inconsistent. These proportions describe selected study-defined outcomes. They do not establish attributable robotic or positioning risk, a safe exposure threshold, or benefit from horizontal breaks. Standardized prospective measurement is needed.
SN - 1863-2483
SN - 1863-2491
ER -