Robotic versus laparoscopic surgery in older adults: a systematic review and meta-analysis of recovery-centered...

Whether the technical advantages of robotic surgery improve recovery beyond conventional laparoscopy in older adults remains uncertain. We synthesized recovery-centered outcomes across surgical specialties. PubMed/MEDLINE, Embase and Cochrane CENTRAL were searched through 12 September 2026. Two authors independently screened 14,050 de-duplicated records and assessed 58 full-text reports. Eligibility, extraction and ROBINS-I domains were completed independently; disagreements were resolved by source-based adjudication. Procedure- and outcome-specific random-effects analyses used restricted maximum likelihood with modified Hartung-Knapp intervals, with DerSimonian-Laird and leave-one-out sensitivity analyses. The searches imported 17,374 records and yielded 14,050 unique records after removal of 3,324 duplicates. Fifty-eight reports underwent full-text review; 17 were excluded and 41 observational comparative studies were included. Thirty-four studies contributed 98 source-verified outcome rows. No randomized trial was identified. Colorectal conversion favored robotics in four cohorts (exploratory OR 0.36, 95% CI 0.18-0.72; I²=23%), whereas colorectal overall morbidity was inconclusive (four cohorts: OR 0.67, 0.43-1.05). Severe morbidity and gastric complication strata were imprecise. Observational evidence suggests fewer conversions with robotic surgery in selected older colorectal cohorts, but residual confounding, cohort overlap and imprecise procedure-specific safety estimates prevent a universal recovery-benefit claim. Frailty and functional recovery remain undermeasured.