Clinical outcomes of robotic-assisted versus laparoscopic cholecystectomy in nonelective procedures: A systematic review and meta-analysis

Abstract

BACKGROUND: Robotic-assisted cholecystectomy (RAC) is increasingly used for patients presenting with acute cholecystitis and other biliary conditions. The safety and efficacy of robotic surgery in elective procedures are well documented; however, evidence supporting its application in urgent and emergent surgery, key components of the acute care setting, remains limited. The aim of this study is to compare the outcomes of nonelective robotic and laparoscopic cholecystectomies. METHODS: A systematic review and meta-analysis were conducted using Embase, Cochrane, and PubMed to identify studies comparing nonelective robotic and laparoscopic cholecystectomy. Outcomes included bile duct injury, overall complications, operative time, conversion to open surgery, conversion to subtotal cholecystectomy, surgical site infection, readmission, mortality, and length of hospital stay. Analyses were performed using R (R Project for Statistical Computing, Vienna, Austria); heterogeneity was assessed using I2 . Sensitivity analyses was performed using leave-one-out, radial, Baujat, and L'Abbé plots. This study was registered in International Prospective Register of Systematic Reviews, number CRD420251090396. RESULTS: Nine retrospective cohort studies in nonelective settings were included, totaling 1,073,587 patients. A total of 93,376 patients (8.7%) underwent RAC. Robotic-assisted cholecystectomy was associated with lower rates of conversion to open surgery (odds ratio, 0.66; 95% confidence interval, 0.54-0.80; I2 = 15.2%). No other outcomes showed significant differences in the overall analysis. Subgroup analyses confirmed lower conversion rates in the studies adjusted for confounders (odds ratio, 0.69; 95% confidence interval, 0.54-0.87; I2 = 50.1%). However, statistical significance was not maintained in the low risk of bias subgroup. CONCLUSION: Robotic-assisted cholecystectomy is associated with lower conversion rates to open surgery, suggesting a potential advantage over conventional laparoscopy in nonelective cholecystectomy. Nevertheless, the current evidence remains limited, and while RAC may offer advantages in this setting, its role as a preferred surgical approach remains to be determined. LEVEL OF EVIDENCE: Systematic Review and Meta-analysis; Level III.