Safety and feasibility of robotic surgery in acute care setting: a systematic review

Acute care surgery includes urgent non-trauma general surgical emergency, in which minimally invasive approaches, notably laparoscopic, are associated with reduced postoperative morbidity and hospital stay. Although robotic surgery has demonstrated advantages in elective procedures, its safety, feasibility, and applicability across a broad spectrum of acute care conditions remain undefined.

We conducted a systematic review in accordance with PRISMA guidelines, searching PubMed/MEDLINE, EMBASE, Web of Science, and the Cochrane Library from inception to December 2024 for studies analyzing the safety profile of robotic approaches in adult care surgery. Primary outcomes included length of stay, postoperative complications, conversion to open surgery, operative time, 30-day readmission, and mortality.

Our search yielded 3,740 results. After proper analysis, a total of eighteen studies were included (2016-2024; n = 4,439,317), in which robotic approaches showed shorter length of stay (0.7-28.46 vs. 1-38.26 days), lower complication rates (2-25.62% vs. 3.7-46%), and fewer conversions (0-11.5% vs. 0-28.7%) compared to laparoscopy, though operative times were longer (67-323 vs. 46-294.5 min). Procedure-specific trends emerged, particularly to robotic cholecystectomy, concerning fewer complications (0.5-25.62% vs. 8.23-21%) and conversions (0-1.9% vs. 1.9-8.57%).

In this review, robotic surgery appears as a safe and feasible alternative in acute care settings, offering potential advantages in hospital stay, postoperative complications, and conversion rates-especially for cholecystectomy and colectomy-despite longer operative durations. Further randomized trials and cost-effectiveness analyses are warranted to define its optimal role.

Level III, Systematic Review Study.

A review protocol for this systematic review was registered at PROSPERO CRD420251025085.