Cutting-edge choices: comparative outcomes of laparoscopic vs robotic cholecystectomy-a systematic review

Minimally invasive techniques, particularly laparoscopic cholecystectomy (LC) and robotic-assisted cholecystectomy (RAC), are now the mainstays in the surgical management of gallbladder diseases. Both techniques are widely used, but there is a paucity of comparative studies with regards to surgical efficacy, cost, and patient recovery time. This meta-analysis aims to compare their key differences to improve clinical practice and outcomes. A PRISMA-compliant systematic review was conducted of peer-reviewed comparative studies evaluating LC versus RAC for benign gallbladder disease. Outcomes included conversion to open surgery, operative time, complication rates, postoperative length of stay, postoperative pain, and cost-effectiveness. Random-effects meta-analysis was performed where appropriate.Six studies were included. RAC was associated with significantly lower odds of conversion to open surgery than LC (OR 0.10, 95% CI 0.01-0.94; p = 0.04), although this finding was based on sparse retrospective data. RAC was associated with longer operative time in the available comparative data. No significant difference was found in postoperative length of stay (MD 0.38 days, 95% CI -0.06 to 0.82; p = 0.09) or overall complication rates (OR 0.57, 95% CI 0.04-7.79; p = 0.67). Pain outcomes were reported using non-standardized measures, limiting firm interpretation. Most studies suggested RAC was more costly than LC, although findings varied by institutional setting and costing method. RAC may reduce conversion to open surgery in selected settings, but broader clinical benefit over LC remains uncertain. Overall, LC remains the more established and economically justifiable approach for most patients undergoing cholecystectomy for benign gallbladder disease, while further high-quality prospective studies are needed to clarify the role of RAC.