Perioperative outcomes of remote robot-assisted cholecystectomy: a single-arm meta-analysis

Remote robot-assisted cholecystectomy is an emerging technology integrating 5G communication and robotic surgical systems, but its perioperative outcomes have not been systematically evaluated. This single-arm meta-analysis aimed to assess the feasibility, safety, and key perioperative parameters of this technique. A systematic search was performed in PubMed, Embase, Web of Science, and Cochrane CENTRAL from inception to May 1, 2026. All original studies (case series, cohort studies) reporting perioperative outcomes of remote robot-assisted cholecystectomy were included, regardless of whether a control arm was present (control-arm data were not used for pooling). A random-effects model was used to pool continuous variables (weighted mean difference) and binary variables (proportions). Pre-planned subgroup analyses (by country, publication time, robotic system type, study design) and leave-one-out sensitivity analyses were conducted. Nine studies involving 216 patients (from China, Italy, the United States, Germany, and the Netherlands) were included. The main pooled results were as follows: surgical success rate, 98% (95% CI: 0.98-1.00) with very low heterogeneity (I² = 0.3%); total operative time, 98.75 min (95% CI: 66.62-130.88 min), high heterogeneity (I² = 98.6%); robotic operative time, 64.91 min (95% CI: 44.77-85.06 min), high heterogeneity (I² = 97.6%); robotic setup time, 20.12 min (95% CI: 14.23-26.00 min), high heterogeneity (I² = 99.1%); length of hospital stay, 2.85 days (95% CI: 2.24-3.46 days), high heterogeneity (I² = 96.6%); estimated blood loss (2 studies), 22.39 mL (95% CI: 6.42-38.36 mL), high heterogeneity (I² = 98.8%). Subgroup analyses showed that robotic setup time was significantly shorter in studies published in or after 2008 (P = 0.015) and in prospective studies (P < 0.001). No significant differences were found in other subgroups (country, robotic system type, study design) for any outcome. Leave-one-out sensitivity analyses confirmed the robustness of all pooled results. Given the single-arm design and the absence of a concurrent control group, all comparisons with on-site robotic surgery are descriptive and hypothesis-generating only. This single-arm meta-analysis provides the first quantitative synthesis of existing evidence on remote robot-assisted cholecystectomy. The technique achieves a high surgical success rate of 98%, and perioperative outcomes (operative time, setup time, hospital stay, blood loss) are fall within range of historical data for on-site robotic cholecystectomy. Setup time has shown a significant decreasing trend in recent years. Although the included studies are mostly small and exhibit high heterogeneity, the available evidence supports good feasibility and early safety of remote robotic cholecystectomy. Large-scale prospective studies and randomized controlled trials are needed to confirm non-inferiority.