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Comparison between open, laparoscopic, and robotic cholecystectomy: a systematic review and meta-analysis
Felipe Mendes Delpino1, Francisco Tustumi1, Marina Martins Siqueira1
1Hospital Israelita Albert Einstein, Center for Studies and Promotion of Health Policies, São Paulo, SP, Brazil.
American Journal of Surgery
|April 29, 2026
Summary
Laparoscopic cholecystectomy significantly reduces mortality and complications compared to open surgery. Its benefits are greatest in lower-income countries, with no added advantage seen with robotic surgery over laparoscopic approaches.
Area of Science:
- Surgical Oncology
- Comparative Effectiveness Research
- Global Health
Background:
- Cholecystectomy is a common surgical procedure.
- Comparisons between open, laparoscopic, and robotic techniques are ongoing.
- The impact of national income on surgical outcomes requires investigation.
Purpose of the Study:
- To compare the outcomes of open, laparoscopic, and robotic cholecystectomy.
- To determine if country income levels influence the effectiveness of different cholecystectomy approaches.
Main Methods:
- Systematic review and meta-analysis of 85 studies (over 7.5 million patients).
- Inclusion of randomized and observational studies up to November 2024.
- Meta-regression analysis incorporating World Bank income classifications.
Main Results:
- Laparoscopic cholecystectomy (LC) significantly decreased mortality (RR 0.16) and complications (RR 0.46) versus open surgery.
- LC also reduced length of stay by 4.08 days compared to open surgery.
- Robotic surgery showed no significant clinical advantages over LC; LC's mortality benefit was greater in low- and middle-income countries.
Conclusions:
- Laparoscopic cholecystectomy offers superior safety and efficacy over open surgery, particularly in resource-limited settings.
- Current evidence does not support a significant difference in outcomes between robotic and laparoscopic cholecystectomy.
- The findings highlight the importance of considering healthcare resource availability when selecting surgical techniques.
