Current evidence and reported experiences for robot-assisted emergency general surgery: systematic review

Emergency general surgery (EGS) represents a significant global healthcare burden. While minimally invasive techniques such as laparoscopy have become standard in elective and emergency settings, the adoption of robot-assisted approaches in EGS (REGS) has been more gradual. The expanding interest in REGS necessitates a comprehensive evaluation of its current role, outcomes, cost implications, and implementation strategies. A systematic review was conducted in accordance with PRISMA guidelines. PubMed, EMBASE, and Cochrane Library were searched up to January 2025 for studies reporting on robot-assisted surgery in emergency general surgical settings. The following domains were assessed: Safety, clinical outcomes, cost, and experiential data, with quality assessment via the Newcastle-Ottawa Scale. Twenty studies involving over 5 million patients were included. The majority were retrospective cohort studies from Western centres, primarily the United States. Common procedures included cholecystectomy, colectomy, and hernia repair. Robotic approaches demonstrated low conversion rates, comparable or shorter lengths of stay, and similar or reduced complication and ICU admission rates versus laparoscopic or open techniques. However, operative times were generally longer, and hospital costs were consistently higher. Implementation strategies across four studies emphasized staged training, multidisciplinary involvement, and institutional support. Study quality ranged from moderate to good, though outcome reporting and cost analyses were inconsistent. Robot-assisted EGS appears feasible and safe in selected patients within institutions equipped with appropriate expertise and infrastructure. While early outcomes are encouraging, widespread adoption is challenged by higher costs and limited high-quality evidence. Future prospective studies, robust cost-effectiveness analyses, and structured implementation models are essential to define the long-term role of robotics in emergency surgical care.