Bedside assistant models in robotic abdominal and pelvic surgery: a systematic review of operative efficiency, training exposure, and perioperative safety

Abstract

Robotic surgery depends on effective bedside assistance, yet staffing models vary between physician and non-physician assistants. We systematically reviewed comparative evidence evaluating these models in robotic abdominal and pelvic surgery. A PRISMA compliant systematic review was performed. PubMed, Embase, Ovid MEDLINE, Cochrane CENTRAL/CCTR and ClinicalTrials.gov were searched from inception to 12 April 2026. Comparative adult clinical studies were eligible if they directly compared physician bedside assistance with non-physician bedside assistance during robot-assisted abdominal or pelvic surgery. The primary outcome domain was operative efficiency. Training exposure and perioperative safety were secondary domains. Risk of bias was assessed using ROBINS-I. Meta-analysis was not performed because of clinical and outcome heterogeneity. The search identified 1587 records, with 4 additional records from other sources. After duplicate removal, 693 records were screened and 22 full texts assessed; 3 observational studies met inclusion criteria. These included colorectal, gynaecologic oncology, and transplant/hepatopancreatobiliary robotic settings. Across studies, non-physician or dedicated bedside assistance was associated with favourable time-based efficiency outcomes, including shorter operative or console time in selected procedures and improved operational metrics in a dedicated team model. Training exposure was inconsistently reported, although one programme-level study found increased fellow primary surgeon participation after implementation of a dedicated robotic team. Safety outcomes did not show an obvious harm signal, but reporting was heterogeneous and studies were subject to confounding. Direct comparative evidence evaluating physician versus non-physician bedside assistant models in robotic abdominal and pelvic surgery is limited. Available data suggest possible efficiency benefits without an evident safety penalty, but stronger prospective studies with standardised efficiency, training and safety outcomes are needed.