In the absence of large trials, it is important for us to discuss whether a well-conducted meta-analysis of smaller randomized controlled trial (RCT) can replace large trials or not. We have evaluated the quality of original literature and methodological quality. The difference between meta-analysis of smaller RCT and the largest randomized trials have also discussed.
Objective To evaluate the methodological quality of clinical practice guidelines and consensuses of robot-assisted surgery. Methods The guidelines and consensuses were screened according to the inclusion and exclusion criteria by searching the domestic and overseas guidelines network and electronic database from 1 January, 2000 to 29 December, 2021. The Appraisal of Guidelines for Research and EvaluationⅡ (AGREEⅡ) instrument was used independently by two evaluators to evaluate the guidelines and consensuses. The consistency test of intraclass correlation coefficient (ICC) was carried out for two evaluators, and the score of guidelines and consensuses in the six domains of AGREEⅡ were calculated. Results A total of 34 guidelines and consensuses were included, including 10 guidelines and 24 consensuses. The ICC was all greater than 0.75, indicating that the consistency of the two evaluators was high. The average scores of the 34 guidelines and consensuses in the six domains of AGREEⅡ (scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability and editorial independence) were 81.0%, 43.5%, 28.2%, 81.5%, 12.7% and 51.7%, respectively. Conclusion These evaluated guidelines and consensuses of robot-assisted surgery still need to be improved in the domains of rigor of development, applicability and editorial independence. With the continuous development of robot-assisted surgery, more guidelines and consensuses based on higher level of evidence will be developed to promote the standardized use of robot-assisted surgery.