Robotic versus laparoscopic general surgery in the emergency setting: a systematic review

Area of Science:

• Minimally Invasive Surgery
• Surgical Technology
• Comparative Effectiveness Research

Background:

• Robot-assisted surgery is expanding in elective procedures, but its role in emergency general surgery is unclear.
• Laparoscopy is the current standard for acute abdominal conditions.
• This review evaluates robotic versus laparoscopic surgery in acute general surgery settings.

Approach:

• A PRISMA-compliant systematic literature search was performed across major databases (MEDLINE, EMBASE, etc.).
• Included studies compared perioperative outcomes of emergency general surgery performed laparoscopically versus robot-assisted.
• Six comparative studies involving 1,063 patients were analyzed.

Key Points:

• Low-level evidence suggests comparable perioperative outcomes for robotic and laparoscopic emergency general surgery in selected cases.
• Laparoscopic bowel resection for inflammatory bowel disease (IBD) showed higher complications.
• Robotic surgery demonstrated shorter hospital stays but incurred higher costs; operative times varied.
• Cholecystectomies showed no difference in operative time, while other procedures took longer robotically.

Conclusions:

• Perioperative outcomes for emergency robotic surgery in specific general surgery conditions appear comparable to laparoscopic approaches.
• Current evidence is limited, necessitating large, well-powered studies for definitive recommendations in acute settings.
• While robotic surgery offers potential benefits like shorter hospital stays, cost remains a significant consideration.