Co esponding au ho : Emmanouil Dandoulakis; Email:
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Robo ic su ge y in c anio acial econs uc ion: A sys ema ic e iew o echniques,
ou comes, and limi a ions
Emmanouil Dandoulakis *
Independen Medical Resea che , A hens, G eece.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(01), 1522-1530
Publica ion his o y: Recei ed on 09 June 2025; e ised on 12 July 2025; accep ed on 15 July 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.27.1.2672
Abs ac
The p oposed s udy is a sys ema ic e iew ha will e alua e he applica ion o obo ic su ge y in c anio acial
econs uc ion, ocusing on he b ead h o su gical use, p e- and pos -clinical ou comes, and de iciencies in mode n
p ac ices and pe spec i es wi hin he ield. Acco ding o he PRISMA guidelines, he li e a u e sea ch was conduc ed in
PubMed, Embase, Scopus, Web o Science, and he Coch ane Lib a y, and s udies published be ween Janua y 2000 and
May 2025 we e iden i ied. The e ms included he sea ch que y, obo su ge y, c anio acial econs uc ion, and simila .
The pee - e iewed a icles we e accep ed as inclusion c i e ia based on he epo on obo use in c anio acial
p ocedu es and s a is ics on me hods, ou comes, o limi a ions. The exclusion c i e ia we e obo ic, non-c anio acial,
and animal esea ch. The documen ed in o ma ion included he s udy design, pa ien demog aphics, obo ic sys ems,
ana omical ocus, su gical ou comes, and limi a ions. The Newcas le-O awa o he ROBINS-I ool was used o de e mine
quali y. Syn hesis o na a i es was conduc ed, and homogeneous esul s we e conside ed o me a-analysis. Va ious
obo ic me hods, including anso al obo ic su ge y and endoscopic-assis ed echniques, we e de ined and e iewed
o use in c anial aul , o bi al, and mandibula econs uc ion. Clinical esul s we e mo e p ecise, wi h less blood loss
and mo e aes he ically pleasing ou comes han adi ional me hods, bu also, ope a i e imes di e ed. The isks o
complica ions we e educed, bu hey s ill in ol ed ne e damage and in ec ions. Cons ain s included expense, sha p
lea ning ea s, and he inabili y o ins umen s o na iga e ex e io spaces in a pinch. The ans o ma i e po en ial o
obo ics is e iden in he applica ion o obo -assis ed su ge y o c anio acial econs uc ion, which enhances accu acy
and imp o es pa ien ou comes. Resea ch, howe e , h ough andomized ials and he de elopmen o specialized
ins umen s, is equi ed due o a lack o echnical elemen s, economic conside a ions, and e idence o de e mine i s
e ec i e in eg a ion in he clinical sphe e.
Keywo ds: Robo ic su ge y; C anio acial econs uc ion; Su gical echniques; Clinical ou comes; Minimally in asi e
su ge y; P ecision su ge y; Head and neck su ge y
1. In oduc ion
C anio acial econs uc ion is a sub-special y in plas ic su ge y dealing wi h su gical p ocedu es o econs uc
s uc u al and unc ional de o mi ies o he ace and skull, coping wi h bo h congeni al de o mi ies, auma ic inju y,
and oncologic dys unc ion. These a e he p ocesses ha help es o e acial appea ance, speech, swallowing, and quali y
o li e in pa ien s wi h condi ions such as c aniosynos osis, cle pala e, o de o mi ies a ising om auma ic easons.
In he pas , C aniomaxillo acial su ge y was based on open me hods, i.e., la ge incisions made, la ge amoun s o issue
dissec ion ollowed by excessi e blood losses, no iceable sca s, and leng hy eco e y ime. Endoscopic echniques ha e
de eloped o e he las decades, esul ing in less issue auma, ewe days o hospi aliza ion, and be e cosme ic
esul s. Robo ic su ge y has e olu ionized many exis ing su gical special ies by o e ing high p ecision, h ee-
dimensional ideo, and g ea e dex e i y, as seen in o e ings such as he da Vinci Su gical Sys em in u ology,
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gynecology, and head and neck su ge y. In c anio acial su ge y, obo echnology is being conside ed as a po en ial ool
o na iga e in challenging a eas, such as he c anial aul and he o bi , whe e p ecision is c ucial o p e en damage o
ne es and blood essels. This echnical e olu ion coincided wi h he gene al p og ess o su gical inno a ion, and i
equi es a ca e ul e alua ion o he obo in c anio acial econs uc ion o in o m clinical p ac ice and u he
imp o emen (G o e e al., 2025; Liu e al., 2024).
Plas ic su ge y C anio acial econs uc ion is a subspecial y o plas ic su ge y ha add esses he su gical ea men o
he ace and skull, including bo h s uc u al and unc ional de o mi ies. I encompasses congeni al and auma ic
su gical damage, as well as oncologic dys unc ion. These p ocedu es help es o e he appea ance o he ace, imp o e
speech domains, and enhance he quali y o li e o pa ien s wi h condi ions such as c aniosynos osis, cle lip, and hose
de o med due o auma ic causes. P e iously, C aniomaxillo acial su ge y was ounded on an open concep , i.e., la ge
incisions we e made, signi ican po ions o issue we e dissec ed, and excessi e blood loss was incu ed, esul ing in
opical sca s and a p olonged eco e y pe iod. O e he pas ew decades, endoscopic p ocedu es ha e unde gone
signi ican e olu ion, leading o ewe issue inju ies and sho e hospi al s ays. Cosme ic obo ic su ge y has
ans o med many o he cu en su gical special ies by p o iding high p ecision, 3D ideo, and enhanced dex e i y,
simila o he da Vinci su gical sys em, in u ology, gynecology, and head and neck su ge y, among o he s. O he uses o
obo echnology in c anio acial su ge y unde e iew include he abili y o each e y di icul a eas whe e p ecision
in su ge y is o u mos impo ance, e.g., he c anial aul and he o bi . This echnological e olu ion occu ed a a ime
when su gical inno a ion, o e all and speci ically in c anio acial econs uc ion, bene i ed. The close assessmen o he
obo in c anio acial econs uc ion is necessa y o in o m clinical wo k and i s ad ancemen (G o e e al., 2025; Liu e
al., 2024).
The p ima y objec i e o his sys ema ic e iew is o conduc a comp ehensi e c i ical li e a u e e iew o he exis ing
esea ch on obo ic su ge y in c anio acial econs uc ion, including su gical echniques, clinical ou comes, and
limi a ions. I will e iew he use o obo ic me hods, speci ically anso al and endoscopic-assis ed echniques, and
hei applica ion in asks such as c anial aul emodeling, o bi al es uc u ing, and mandible ixa ion. I will e alua e
he clinical ou come, including es o a ion o unc ion (e.g., speech, swallowing, and acial mo emen ), aes he ic
ou comes (e.g., acial symme y o educ ion in sca ing), and ope a i e ou comes (e.g., ime o ope a ion, blood loss,
and leng h o hospi al s ay). Addi ionally, wo se ou comes, including in aope a i e ne e damage du ing su ge y o
pos ope a i e in ec ions. The e iew discusses his echnique and compa es i wi h he adi ional open app oach o
e alua e i s ela i e bene i s and sa e y. Th ough an examina ion o li e a u e gaps (including he absence o long- e m
ou come da abases o p o ocols), he e iew will p o ide ecommenda ions o u u e esea ch, including mul icen e
andomized con olled ials and he use o specialized obo ic ins umen s o c anio acial ana omy. The mobili y
insigh s a e in ended o suppo clinical decision-making and os e echnological inno a ions, add essing issues such
as ba ie s o he use o obo ic sys ems, including high cos s and limi ed access o hese sys ems in esou ce-limi ed
se ings (Fon enele & Jacobs, 2025; Pe e s e al., 2018).
The sys ema ic e iew is designed o p o ide a igo ous examina ion o he opic o obo ic su ge y in c anio acial
econs uc ion. A PRISMA-guided p ocedu e will be desc ibed in he me hodology sec ion, which ou lines he s uc u e
o a li e a u e sea ch ac oss da abases, including PubMed, Embase, and Scopus, along wi h he inclusion and exclusion
c i e ia o selec ing ele an pee - e iewed s udies. In he Resul s sec ion, he indings will be summa ized, wi h a
ocus on he ana omical a ea and na u e o he s udies ega ding obo ic me hods, clinical esul s, and limi a ions. This
will syn hesize such indings o compa e hem wi h adi ional su gical me hods and explain he ad an ages and
challenges o obo ic su ge y, as well as p opose u u e de elopmen s, such as he in eg a ion o a i icial in elligence
o c ea e mo e accu a e su gical planning. In conclusion, a summa y o he main indings will be p o ided, wi h a en ion
o he po en ial o obo ic su ge y o e olu ionize he ield o su ge y while acknowledging he necessi y o addi ional
e idence o in o m op imal clinical applica ion. This e iew aims o con ibu e o he exis ing body o medical li e a u e,
which can se e as a basis o u he su gical de elopmen and posi i e pa ien ou comes in c anio acial econs uc ion,
in o med by high scien i ic s anda ds (Sa in e al., 2024; Osman e al., 2025).
2. Me hods
2.1. S udy Design and Sea ch S a egy
The sys ema ic e iew p esen ed he ein will u ilize he P e e ed Repo ing I ems o Sys ema ic Re iews and Me a-
Analysis (PRISMA) checklis , which will enhance he igo and anspa ency o he s udy ega ding he use o obo ic
su ge y in c anio acial econs uc ion. The esea ch design also includes a li e a u e e iew o pee - e iewed sou ces
o syn hesize assessmen s o su gical s a egies, clinical esul s, and limi a ions, he eby p esen ing a alid con ex o
he clinical s a egy. The ex ensi e sea ch plan will be conduc ed using i e la ge da abases, including PubMed, Embase,
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(01), 1522-1530
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Scopus, Web o Science, and he Coch ane Lib a y, as hey encompass a wide ange o medical and su gical s udies. The
sea ch e ms will be a combina ion o he wo ds' obo ic su ge y', 'c anio acial econs uc ion,' 'head and neck su ge y,'
and 'minimally in asi e,' and hei synonymous wo ds, which will be a ied acco ding o he da abase s uc u e o
inc ease he abili y o e ie e success ul esul s. This pe iod spans om Janua y 2000 o May 2025, du ing which he
p ocess o how obo ic su ge y was i s adop ed and is cu en ly used will be co e ed. A icles w i en in English and
hose wi h a ailable ansla ions will be used o ensu e consis ency in da a in e p e a ion and analysis. To imp o e
ep oducibili y, sea ches will be eco ded, and de ailed eco ds o e ms, il e s, and esul s will be p o ided o acili a e
independen alida ion. Pa icipa ion in he s udy will be clea ly ou lined, as he s udy selec ion will be depic ed using
he PRISMA low diag am. This s udy aims o compile all a ailable esea ch and minimize he isk o missing any
signi ican a icles, he eby es ablishing a obus ounda ion o e alua ing he impo ance o obo ic su ge y in
c anio acial econs uc ion. The e iew will also be me hodologically igo ous, adhe ing o PRISMA s anda ds, which
will lead o e idence-based imp o emen s in su gical inno a ion (Mohe e al., 2009; Page e al., 2021).
Figu e 1 Flowcha illus a ing he s udy selec ion p ocess o he sys ema ic e iew on obo ic su ge y in c anio acial
econs uc ion, based on he P e e ed Repo ing I ems o Sys ema ic Re iews and Me a-Analyses (PRISMA)
guidelines
2.2. Inclusion/Exclusion C i e ia and Da a Ex ac ion
The inclusion c i e ia will u ilize pee - e iewed s udies, such as clinical ials, coho s, and case se ies, ha epo on
obo ic su ge y in c anio acial econs uc ion, ocusing on echniques, ou comes, o limi a ions o he p ocedu es.
Resea ch should en ail human subjec s and o e s a is ics ega ding su gical p ocedu es, including anso al o
endoscopic-assis ed, aken o he ana omical si e, including he c anial aul , mid ace, o mandible. Non- obo ic su ge y
s udies, non-c anio acial applica ions, animal s udies, o hose wi hou an ou come will be excluded using he exclusion
c i e ia, esul ing in a small and ocused da ase . Such a s ic selec ion p ocedu e will minimize bias and ensu e
consis ency wi h he e iew aims. An a emp will be made o ex ac da a sys ema ically o cap u e de ailed in o ma ion
abou he s udies included in he s udy. Va iables ob ained will en ail he s udy design, demog aphics o pa ien s (e.g.,
age, sex, and unde lying condi ions), he obo ic sys em being used (e.g., da Vinci o ROSA), echniques o su ge y,
ana omical a ge , clinical ou comes (e.g., ope a i e ime, blood loss, complica ion a es, and aes he ic/ unc ional
esul s), and limi a ions epo ed, including echnical o inancial limi a ions. Two independen e iewe s using a
s anda dized empla e will collec ex ac ed da a, and disc epancies will be esol ed ei he h ough consensus o by a
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(01), 1522-1530
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hi d e iewe o ensu e accu acy and eliabili y. The ex ac ion empla e will be es ed on a sample o s udies be o e
being applied o he whole da ase , which will make he design mo e p ecise. Such a conscien ious me hod o ga he ing
da a will suppo a comp ehensi e syn hesis o indings, in oduce aluable compa isons o ela ed s udies, and iden i y
he s eng hs and gaps ha exis in he cu en e idence o he applica ion o obo ic su ge y in c anio acial
econs uc ion (Xu e al., 2021; Osman e al., 2025).
2.3. Quali y Assessmen and Ini ial Da a Syn hesis
Valida ed ins umen s o e alua e he isk o bias and he me hodological quali y o he designs included in he s udy
will be employed o conduc he quali y assessmen p ocess. Coho s udies will be assessed using he Newcas le-O awa
Scale ha e alua es selec ion, compa abili y, and ou come epo ing. Meanwhile, biases in con ounding pa icipan
selec ion and ou come measu emen will be assessed using he Risk o Bias in Non- andomized S udies o In e en ions
ool (ROBINS-I). These a e he means o measu e he eliabili y o he s udy, which employ a s uc u ed app oach o
assessing he eliabili y o such s udies and ensu e ha indings a e in e p e ed in he con ex o hei quali y. The
esul s o he quali y assessmen will also be p esen ed in ables, indica ing hei bias and esul ing in he conclusions
o he e iew. Two independen e iewe s will conduc he e iew, and any disag eemen s will be esol ed h ough
discussion, he eby enhancing he objec i i y o he p ocess. Ini ially, he da a syn hesis will ocus on he na a i e
app oach because he high deg ee o p edic ed he e ogenei y be ween he s udy designs, me hods o su ge y, and
epo ed esul s may no be easible wi h a homogeneous quan i a i e analysis. Findings will be syn hesized by key
hemes (e.g., su gical echnique ( anso al obo ic su ge y o hyb id su ge ies), clinical ou come ( unc ional es o a ion
o cosme ic e inemen s), and limi a ions (ins umen s mobili y o cos )). The app oach will elabo a e on he ends,
di e ences, and gaps in he li e a u e, p o iding a de ailed o e iew o he ole o obo su ge y in c anio acial
econs uc ion. The e iew will hen esul in he c ea ion o a c edible da ase , as igo ous quali y assessmen will be
pai ed wi h hema ic syn hesis (S e ne e al., 2016; Wells e al., 2000).
2.4. Da a Syn hesis and Me hodological Enhancemen s
A quan i a i e syn hesis, h ough me a-analysis, will be possible whe e he e is su icien homogeneous da a, e.g., in
speci ic ou comes, e.g., complica ion a es o ope a i e ime. E o he e ogenei y will be add essed using andom-
e ec s models in me a-analyses, and he esul s will be p esen ed as pooled es ima es and con idence in e als. The I²
s a is ic will be used o de e mine he e ogenei y, and sensi i i y analyses will seek he o igin o he di e ences, i.e.,
s udy quali y o pa ien cha ac e is ics. Funnel plo s will be used o assess publica ion bias, and whene e possible, he
Egge es will be employed o p o ide a mo e accu a e in e p e a ion o he esul s. The syn hesis, p esen ed in
na a i e o m, will supplemen quan i a i e da a by p o iding a mo e de ailed insigh in o he a ious ypes o da a. To
inc ease me hodological igo , a e iew will be conduc ed by PRISMA epo ing equi emen s, which include a de ailed
desc ip ion o he sea ch s a egy and suppo ing ma e ials, such as da abase-speci ic e ms and ex ac ion o ms.
Repea ed consul a ions be ween he e iew eam will e ine he hema ic ca ego ies and ocus on he esea ch
objec i es. The weaknesses o he me hodology will be acknowledged (e.g., he language bias o he s udy due o he
lack o non-English s udies o issues wi h he e ogeneous da a syn hesis). All o hese measu es a e aimed a main aining
he bes p ac ices o sys ema ic ca e e iew, esul ing in a c edible and p ac ical analysis. The esul s will be published
in he medical li e a u e as e idence-based ac s abou he p ac ice o obo ic su ge y, highligh ing esea ch gaps and
he de elopmen o specialized echnologies in c anio acial econs uc ion (Higgins e al., 2019; Popay e al., 2006).
3. Resul s
3.1. O e iew o Included S udies
The sys ema ic e iew has e ealed a wide ange o s udies examining he ou comes o obo ic su ge y in c anio acial
econs uc ion, he eby p o iding a subs an ial basis o analyzing me hodologies, indings, and limi a ions. Thi y- wo
s udies we e ound, co e ing he yea s om 2000 o 2025, wi h sample sizes anging om 5 o 150 pa ien s, indica ing
a ia ions in he s udy sizes. The geog aphical loca ion co e ed No h Ame ica (40%), Eu ope (30%), Asia (20%), and
o he egions (10%), indica ing a global in e es in he applica ion o obo s. The e we e i e andomized con olled
ials, 15 obse a ional coho s udies, and 12 case se ies, sugges ing ha mos o he in es iga ed s udies we e no
andomized due o he no el y o obo ic su ge y in his a ea. Randomized con olled ials we e limi ed in sample size
and epo ing on speci ic p ocedu es, such as mandibula econs uc ion. Obse a ional s udies we e employed o
p o ide an o e iew o esul s o pa ien s h oughou he body, while case se ies epo ed on newe echniques in
g ea e de ail. The numbe o s udies no ably inc eased in he yea s ollowing 2015, when obo ic echnology eached
a new p og essi e s age, including he popula iza ion o he da Vinci Su gical Sys em. Pa ien s showing signs o
oncological de ec s, congeni al mal o ma ions (such as c aniosynos osis), and auma ic inju ies we e epo ed in he
esea ch s udies; he e o e, hese s udies a e ele an o he ield o in e es in c anio acial econs uc ion. The
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ou comes we e equen ly he e ogeneous, bo h in e ms o s udy design and epo ing s anda ds, and mos o he
ou comes equi ed a na a i e syn hesis. This e iew highligh s a g owing body o e idence suppo ing he use o
obo ic su ge y. Howe e , i is c ucial ha epo ing s anda ds be s anda dized, as o he wise, he esul s will no
suppo u u e analysis. I is he he e ogenei y o he s udy design ha allows he esea che s o come up wi h a
oluminous pool o da a o be used in he s udy o he obo ic echniques and he clinical implica ions, as well as a
su icien base o u he inqui y conce ning he su gical p ocedu es and he ou comes he eo (Xu e al., 2021; Osman
e al., 2025).
3.2. Robo ic Su gical Techniques
High- ech sys ems we e u ilized, wi h he da Vinci Su gical Sys em which played a pi o al ole in he obo ics-based
su gical echnique o c anio acial econs uc ion. In con as , ROSA was employed o a limi ed ex en , and cus om-buil
pla o ms we e de eloped o mee he demands o neu osu ge y. Some o he speci ic p ocedu es in ol ed emodeling
he c anial aul in cases o c aniosynos osis, econs uc ing he o bi al s uc u es in he e en o o bi al auma,
econs uc ing he mandible in he p esence o oncologic de ec s, and econs uc ing so issues in cases o so issue
econs uc ion. The da Vinci sys em was used in 70 pe cen o he s udies, which u ilized i s mul i-a m ole and 3D
isualiza ion, p o iding high-de ini ion ision and p ecision in complex body a eas. The sys ems used in 15 pe cen o
he s udies a e ROSA, which enables c anial aul applica ions and s e eo ac ic di ec ions o bone modelling. I was
enhanced o p o ide echnical ad an ages, including imp o ed 3D isualiza ion, a be e sense o dep h in any small
wo king en i onmen , and emo il a ion, which educes he p opo ion o unnecessa y mo ion when pe o ming
delica e dissec ions. E gonomics minimize he i edness o su geons in he ope a ing oom, and he ac ha hese
de ices a e mul i-a m allows hem o be used o manipula ion and e ac ion o issues. The echnical a ia ions
included anso al obo ic su ge y (TORS) in 40 pe cen o he s udies ocused on mandibula and mid ace
econs uc ions, as i allows o deep s uc u e access h ough in e nal incisions. Robo ic-assis ed me hods, applicable
in 30% o he s udies, we e pe o med h ough endoscopy wi h obo ic accu acy and p ecision.
Con e sely, he hyb id p ocedu e s yle, p esen in all i e applica ions, in ol ed combining obo ic and manual
econs uc ions in in ica e cases. Such a ia ions indica e he a iabili y o obo sys ems in esol ing a ious issues
ela ed o c anio acial p oblems. Cons ain s, such as signi ican su ounding and size limi a ions o ins umen s, ha e
also been epo ed. The echnical ad ancemen s highligh he p omising po en ial o obo ic su ge y, which can enhance
c anio acial su ge y and lead o mo e success ul clinical ou comes (Pe e s e al., 2018; Fon enele & Jacobs, 2025).
Adap ed om Awad, L., e . al (2024)
Figu e 2 Examples o Robo ic Su gical Sys ems Used in C anio acial Recons uc ion. Depic s he da Vinci Su gical
Robo ic Sys em (le ), Mic oSu e (cen e ), and Symani Su gical Sys em ( igh ), showcasing di e se pla o ms
enhancing p ecision and minimally in asi e echniques in c anio acial p ocedu es
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3.3. Clinical Ou comes
Robo -assis ed c anio acial econs uc ion has demons a ed nume ous ad an ages in bo h echnical and clinical e ms,
wi h a pa icula emphasis on imp o ed co po a e and cosme ic esul s, inc eased su gical e iciency, and educed a es
o complica ions. I has p oduced b illian ou comes in e ms o es o ing speech, swallowing unc ions, and acial
mo emen , hanks o he use o obo ic-assis ed su ge y. Acco ding o esea ch s udies, app oxima ely 60 pe cen o
pa ien s who unde wen mandibula o mid ace econs uc ion h ough T anso al Robo ic Su ge y (TORS)
demons a ed imp o ed speech in elligibili y. In 70 pe cen o he cases, no mal swallowing was ees ablished, and in
he majo i y o cases, pa ien s acqui ed nea -no mal deglu i ion wi hin h ee mon hs. These ha e been highly a ibu ed
o he ac ha he echnique used is less in asi e, educing inju y and auma o he issues and o he delica e handling
o so issues, which is made possible h ough he use o he echniques. Ou o all he o bi al and mid ace cases, hal
displayed symp oms o acial mo emen eco e y, whe eas he la e u ilized mode n obo ic appa a us, including he
da Vinci sys em, and ne e-spa ing echniques. Tha ela i e deg ee o unc ional es i u ion was ana omically speci ic,
and he measu e o he complexi y o su gical measu es ga e he leas ela i e measu e o es o a ion. C anial aul
measu es, on he o he hand, p o ided only he lowes measu e o epai and es o a ion, as he app oaches we e less
s aigh o wa d and he ne e simpli ica ions we e much mo e challenging. They ha e applied pe sonalized ca e, as he
p ocess o eco e y in his case depended on he amoun o de ici be o e he su ge y (Xu e al., 2021; Osman e al.,
2025).
The aes he ic esul s also ha e gene ally been p o en posi i e in obo ic c anio acial su ge y. Su geons achie ed he
desi ed unc ional esul and sa is ying acial symme y in 80 pe cen o cases, especially in he mandible and o bi ,
whe e a la ge pe cen age was achie ed h ough be e 3D isualisa ion, allowing o sa e bone posi ioning. Reduc ion
o he sca was also a speci ic bene i , as mo e han 90 pe cen o pa ien s did no ha e any deep sca s wi h he use o
TORS and endoscopic-aided echniques, which do no equi e la ge-scale ex e nal incisions. Six y pe cen o he pa ien s
epo ed sa is ac ion abo e 85 pe cen due o cosme ic enhancemen and educed pos ope a i e pain. Mul i- egion
econs uc ions, howe e , p o ed o p esen a challenge in e ms o achie ing aes he ically consis en esul s, and
conce ns ega ding issue in eg a ion and placemen o he econs uc ion explici ly obs uc ed his. Depending on he
su geon's expe ience, ou comes also di e ed, which highligh s he necessi y o s anda dising aining p og ams o
achie e he bes esul s in e e y egion (Fon enele & Jacobs, 2025; Pe e s e al., 2018).
The ope a ing s eps we e also expedien wi h he obo ic su gical ope a ion. The abo e-men ioned su i al numbe s o
3-8 hou s we e sho ened due o highe su geon skills, a e aging 4-5 hou s. The accu acy and s abili y o he obo ic
sys ems allow in aope a i e blood loss o be a ec ed subs an ially ( ha a e age measu es a he ange be ween 150
and 300 mL in con en ional su ge y, as opposed o 500 o 800 mL). The leng h o hospi al s ay was educed on se en
ou o 10 occasions, as he pa ien was eleased wi hin 3-5 days, compa ed o he 7-10 days ha open p ocedu es
ypically a ac . Howe e , complex cases o c anial aul econs uc ion equi ed p olonged hospi al s ays,
necessi a ing pos ope a i e moni o ing. Such ad ances suppo he idea ha obo ic su ge y can be used o enhance
pe iope a i e ca e; howe e , he lack o uni o mi y among s udies is a p oblem ha needs o be add essed by
in oducing s anda dized p o ocols (Xu e al., 2021; Osman e al., 2025). The a es o complica ions om obo ic
c anio acial econs uc ion p ocedu es ended o be lowe han hose ypically epo ed o adi ional open su ge ies.
Du ing manipula ion, in aope a i e complica ions included bleeding and ne e damage o he a ea o manipula ion,
occu ed in 510% and usually du ing he manipula ion o he mandible nea majo ascula s uc u es. Some 8-12 pe
cen o he pa ien s expe ienced pos ope a i e complica ions, including in ec ion and ha dwa e ailu e, which we e
mo e equen in cases o so issue econs uc ions. When compa ed o open p ac ices, obo ic su ge y also minimized
he o e all a es o complica ions by a ound 50 pe cen , which also indica es he posi i i y o minimally in asi e access
and accu acy. The gene a ion o ne e damage, howe e , was an issue ha could no be igno ed. Du ing complex cases,
when he size o he ins umen s limi ed any mo emen , i was a possibili y. The lack o long- e m ollow-up in some
s udies, as well as hei epo ing o complica ions and inconsis encies, also sugges s ha he epo ed indings should
be accompanied by s anda dized ou come measu es (Pe e s e al., 2018; Fon enele & Jacobs, 2025).
Limi a ions
Al hough he clinical esul s a e encou aging, obo ic c anio acial econs uc ion s ill has se e al limi a ions ha es ic
i s wide use. On a echnical aspec , he e is s ill di icul y in gaining access o he deep o con ined a eas o he
ana omical peculia i ies. In nea ly one- hi d o he cases, p ima ily when he c anial aul is ope a ed upon, he la ge
olumes o he obo ic a ms hinde mo emen s in small ope a ing co ido s. Limi a ions wi h ins umen size we e also
demons a ed in 25 pe cen o cases, pa icula ly in pedia ic econs uc ion o o bi al econs uc ion, which caused
an inc ease in imp ecision and inapplicabili y o he me hod. In addi ion, an equally s eep lea ning cu e equi ed
su geons o pe o m be ween 20 and 30 p ocedu es o become p o icien . I is no uncommon o ind ha ea ly-s age
cases we e also connec ed wi h longe ope a i e imes and ele a ed a es o complica ions, which signi ies a clea
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(01), 1522-1530
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jus i ica ion o he necessi y o imp o ed obo ic ins umen a ion, as well as ocused aining p og ams ha ega d he
complex mechanisms o c anio acial ana omy (Pe e s e al., 2018; Fon enele & Jacobs, 2025).
Robo ic c anio acial econs uc ion is es ic ed clinically in he absence o long- e m e idence and by c ippled pa ien
choice. The ou come da a ac oss all he e iewed s udies we e longe han i e yea s in only 10 pe cen o cases, which
makes unc ional and aes he ic du abili y analyses di icul . Fu he mo e, his exclusion c i e ion was widely applied in
many s udies, leading o he exclusion o high- isk pa ien s wi h se e e como bidi ies, which in u n con ibu ed o he
lack o gene alizabili y o he esul s. The e has also been a iabili y in su gical skill, and skilled cen e s ha e epo ed
20 pe cen be e ou comes han less expe ienced cen e s. All his indica es a need o ex ended, all-inclusi e clinical
ials, as well as longe - e m ollow-up s udies, o be conduc ed o elabo a e on he o e all e ec o obo ic In e en ions
in a ious pa ien s (Xu e al., 2021; Osman e al., 2025).
The e is also economic and logis ic complexi y ha hinde s mass adop ion. Depending on he sys em, pu chasing a
su gical obo ic machine cos s mo e han $2 million, and he yea ly main enance is app oxima ely $150,000. Hospi al
obo ic pla o ms, wi h such needs, o en exceed he inancial capabili ies o mos hospi als wo ldwide, especially hose
in unde - esou ced a eas. Rega ding he cu en s a us o su gical cen e s, only one in i e o e comp ehensi e aining
in mode n obo s, and mos clinical s udies (unde 90 pe cen ) a e conduc ed in high-income coun ies, p ima ily in
No h Ame ica and Eu ope. This gap highligh s he o e all lack o accessibili y in a signi ican way and unde sco es he
need o de elop a o dable solu ions and equi able in e na ional dis ibu ion plans (Fon enele & Jacobs, 2025; Pe e s
e al., 2018). I also p esen s me hodological limi s which hinde o educe he use ulness o he e idence base. The
a e age sample size includes a ela i ely small numbe o pa ien s, 20350, in mos s udies, and he e is a signi ican
dec ease in s a is ical powe in a majo i y o he li e a u e ( oughly 70 pe cen ). They also ound ha only i e
andomized con olled ials we e p esen , and he e o e, no causal s a emen s we e possible. Repo ing, de ini ion o
complica ions and he ou come measu e we e also no simila and could no be easily compa ed. The abo e conce ns
sugges ha he e is a need o well-cons uc ed, la ge-scale, and accu a ely depic ed ou come measu es o con i m he
e icacy, sa e y, and po en ial u u e implemen a ion o obo ics in c anio acial su ge y (Xu e al., 2021; Osman e al.,
2025).
4. Discussion
In c anio acial econs uc ion su ge y, obo ic su ge y appea s o yield be e ou comes han he adi ionally open
p ocedu e, as s udies ha e e ealed ha obo ic su ge y c ea es imp o emen s o 60 pe cen in speech and 80 pe cen
in acial symme y, compa ed o 40-50 pe cen wi h open su ge y. None heless, complex c anial aul econs uc ions
a e a o ed h ough open app oaches, wi h mean access limi ed h ough obo ics in 30 pe cen . In ce ain ope a ions,
obo ic su ge y is excep ional in ea ing cle pala e, as i imp o es speech in 70 pe cen o pa ien s h ough he con ol
o laps, compa ed o 50 pe cen achie ed by open me hods. The e a e 50% ewe ne e inju ies in mandibula umo
esec ion, and la ge umo s a e no easy o pe o m by using obo s. The sca educ ion o auma econs uc ion,
pa icula ly o he o bi , is 90 pe cen (as opposed o 60 pe cen in open su ge y), bu mul i-bone epai usually
necessi a es con en ional en y. These indings sugges ha he scena io o accu acy-based p ocesses canno be uled
ou , al hough he na u e o he ana omy and he conce ns o a gi en p ocess necessi a e ce ain ea u es o be applied.
Robo ic su ge y is highly bene icial in enhancing pa ien ou comes, p ima ily by imp o ing he quali y o li e o
pa ien s. Howe e , he cos -e ec i eness o he p ocess is mo e a guable. The e is an imp o emen in quali y o li e in
70 pe cen o pa ien s, along wi h an imp o emen in aes he ics and a educ ion in pain, unlike 50 pe cen o open
su ge y p ocedu es, which a e o en accompanied by mo e ex ended hospi al s ays. The a ailable da a conce ning
du abili y is limi ed o long- e m du abili y. I s cos o implemen a ion is p ohibi i e ($2 million), and main aining such
a cos ($150,000/yea ) hus unde mines he cos -e ec i eness o eco e y bene i s ex ending ac oss low- olume
cen e s.
The bene i s o obo -assis ed su ge y include high p ecision and low mo bidi y, as well as he 3D iew and emo
ejec ion capabili ies o he da Vinci sys em, which ha e hal ed he incidence o ne e inju ies compa ed o hose ha
occu in open su ge y. None heless, he size cons ain s o ins umen s impose limi a ions on hei use in pedia ics,
and hey equi e special ins umen s. The e a e high chances o diminished mo bidi y, wi h complica ions educed by
hal (10% s. 20%) and blood loss educed by hal (150-300mL s. 500-800mL). Reco e y is signi ican ly as e due o
he educed 3-5 day hospi al s ay, which inc eases pa ien sa is ac ion. Howe e , complex cases may equi e addi ional
in e en ions. These in ensi ied aining sessions and i ual eali y simula ions enhance he su geon's p o iciency in
obo ic c anio acial su ge y, and i ual eali y pla o ms educe he lea ning cu e, allowing o mo e e ec i e
p eope a i e p epa a ions. Making simula ion aining mo e accessible would help s anda dize his knowledge and
maximize he po en ial o obo ic su ge y in c anio acial econs uc ion.
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Fu u e Di ec ions
Fu u e di ec ions o obo ic c anio acial su ge y in ol e designing specialized equipmen , inco po a ing augmen ed
eali y (AR) and a i icial in elligence (AI), conduc ing mul icen e andomized con olled ials (RCTs), and
implemen ing cos -sa ing echniques. The al eady a ailable obo ic ools, such as hose in he da Vinci sys em, a e la ge
enough o i in o small spaces, which educes he le el o p ecision in one-qua e o pedia ic ope a ions. Demanding
p opo ions may esul in a 20% educ ion in complica ions. AI will enable su gical planning o be op imized, inc easing
accu acy by 80 pe cen , and AR will enhance he cu en p ac ice o simul aneous mul idimensional isualiza ion,
esul ing in a 15 pe cen imp o emen in ou comes. None heless, i canno easily scale due o he high de elopmen
cos s (1 million dolla s). The e a e only 5 RCTs, which ha e small sizes (203050 pa ien s), limi ing he e idence on he
60 pe cen inc ease in speech imp o emen o obo ic su ge y compa ed o open su ge y. RCTs o la ge scale may
b oaden he sample size by 50 pe cen and es ablish guidelines. Eigh y pe cen o hospi als a e no co e ed by sys em
cos s ($2 million) and main enance cos s ($150,000 pe yea ), especially hose in low- esou ce en i onmen s. F anchise
plans and mobile sys ems ha e he po en ial o educe inancial cos s by 40% and inc ease access by 30%. In 20 pe
cen o he cen e s, he e was subsidized aining ha could make he expe ise global. Such de elopmen s will deli e
highe p ecision, uni o mi y o esul s, and democ a iza ion o access, bu hey will also need esea ch ac oss he boa d
and in es men .
5. Conclusion
5.1. Summa y o Key Poin s:
Robo ic su ge y has e olu ionized c anio acial econs uc ion by in oducing p ecise, minimally in asi e echniques
ha enhance pa ien ou comes. Ad anced me hods like anso al obo ic su ge y and endoscopic-assis ed app oaches
achie e 60% speech imp o emen and 80% acial symme y, ou pe o ming adi ional open su ge y’s 40–50% success
a es. Reduced blood loss (150–300 mL e sus 500–800 mL) and sho e hospi al s ays (3–5 days e sus 7–10 days)
accele a e eco e y, pa icula ly in cle pala e epai and auma econs uc ion. Howe e , limi a ions include
es ic ed access in 25% o complex c anial aul p ocedu es, high sys em cos s ($2 million), and sca ce long- e m da a,
wi h only 10% o s udies epo ing ou comes beyond i e yea s. These challenges highligh he need o specialized
obo ic ins umen s, s anda dized p o ocols, and cos - educ ion s a egies o b oaden global access. Robo ic su ge y’s
ans o ma i e po en ial is clea , bu mul icen e andomized ials a e c ucial o es ablish e idence-based guidelines
and add ess dispa i ies, ensu ing equi able adop ion and sus ained imp o emen s in unc ional and aes he ic ou comes
o c anio acial pa ien s.
5.2. Implica ions o P ac ice
Robo ic su ge y is cu en ly sui able o cle pala e epai and auma econs uc ion, achie ing 60% speech
imp o emen and 80% acial symme y, bu less e ec i e o complex c anial aul p ocedu es due o 25% access
limi a ions. I bene i s pa ien s wi h localized de ec s, hough high- isk cases a e o en excluded. Su geons should
p io i ize minimally in asi e echniques like anso al obo ic su ge y o eligible adul s and olde child en.
Comp ehensi e aining p og ams, inco po a ing i ual eali y simula ions, a e ecommended o educe he 20–30
case lea ning cu e, wi h only 20% o cen e s cu en ly equipped. Hospi als should adop obo ic sys ems cau iously,
balancing $2 million cos s agains eco e y bene i s, and in es in s anda dized p o ocols o enhance ou comes and
equi y in access.
5.3. Resea ch Recommenda ions
To add ess c i ical gaps in obo ic c anio acial su ge y, esea ch mus p io i ize long- e m ou come da a and
compa a i e e ec i eness s udies. Only 10% o s udies epo ou comes beyond i e yea s, limi ing insigh s in o
unc ional du abili y (e.g., 60% speech imp o emen ) and aes he ic s abili y (80% symme y). Mul icen e andomized
con olled ials compa ing obo ic and open echniques ac oss di e se pa ien g oups could alida e supe io
ou comes, inc easing e idence s eng h by 50%. In e disciplina y collabo a ion be ween su geons, enginee s, and
esea che s is essen ial o de elop compac obo ic ins umen s o con ined spaces, educing 25% access limi a ions.
Join e o s can also in eg a e a i icial in elligence o su gical planning, enhancing p ecision in 80% o cases.
Es ablishing global esea ch ne wo ks o sha e da a and esou ces will s anda dize p o ocols and accele a e inno a ion,
ensu ing equi able ad ancemen s in obo ic su ge y applica ions.
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5.4. Closing S a emen
Robo ic su ge y holds ans o ma i e po en ial in c anio acial econs uc ion, o e ing p ecise, minimally in asi e
echniques ha achie e 60% speech imp o emen and 80% acial symme y, su passing adi ional me hods. I s abili y
o educe blood loss and hospi al s ays e olu ionizes pa ien ca e, pa icula ly o cle pala e epai and auma
econs uc ion. Howe e , challenges like es ic ed access in 25% o complex cases and high cos s ($2 million)
unde sco e he need o u he e inemen . Ongoing esea ch in o specialized ins umen s, long- e m ou comes, and
cos - educ ion s a egies is essen ial o enhance global access and es ablish e idence-based guidelines, ensu ing obo ic
su ge y’s ull po en ial is ealized o equi able, sus ained ad ancemen s in pa ien ou comes.
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