Clinical outcomes of laparoscopic versus robotic cholecystectomy approaches: a systematic review and GRADE assessment...

Laparoscopic cholecystectomy is the standard treatment for symptomatic cholelithiasis, cholycystitis and other gall bladder diseases. The adoption of robotic-assisted surgery has increased, but its comparative clinical outcomes remain debated. This meta-analysis compares the clinical outcomes of robotic versus laparoscopic cholecystectomy. A comprehensive literature search was conducted in PubMed, Cochrane, Scopus and Embase from inception until August 2025 to identify relevant studies. Risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes with 95% confidence intervals (CI) were calculated using a random-effects model. Heterogeneity was assessed using I² and X² statistics. Statistical analysis was performed using RevMan 5.4.1. A p value < 0.05 was considered statistically significant A total of 1,770,300 patients across twenty five included studies were analyzed. Pooled results showed no significant differences between robotic and laparoscopic cholecystectomy in terms of surgical success rate (OR = 1.71, 95% CI: [0.85-3.44]), overall complications (OR = 0.96, 95% CI: [0.89-1.04]), postoperative complications (OR = 0.99, 95% CI: [0.94-1.04]), 30-day readmission (OR = 1.00, 95% CI: [0.93-1.08]), length of hospital stay (MD=-0.02 days, 95% CI: [-0.29 to 0.25]), and major bile duct injury (OR = 1.42,95% CI[0.43-4.66]). Robotic cholecystectomy was associated with a significantly lower conversion to open surgery (OR = 0.35,95% CI: [0.31-0.41], p < 0.00001) but required longer operative time (MD = 12.65 min, 95% CI: [6.95-18.35], p < 0.0001). Robotic cholecystectomy is a safe and effective alternative to the laparoscopic approach, demonstrating equivalent success and complication profiles with a distinct advantage in reducing conversions to open surgery. The high heterogeneity for some outcomes suggests careful patient selection is warranted.