Presentation (CTI)

OBJECTIVES: To compare the perioperative outcomes for robotic-assisted surgery(RAS) using da Vinci surgical systems, laparoscopic-assisted(Lap), and open surgery for cholecystectomy.
METHODS: Systematic literature review and meta-analysis of publications identified from Pubmed, Scopus and Embase was conducting using PRISMA methods. Studies comparing RAS with Lap and open approaches for elective/emergent benign cholecystectomies were included. Studies on pediatric cases, malignancies, irrelevant outcomes, or redundant data were excluded. Outcomes assessed were operative-time, conversions, transfusions, blood loss(EBL), hospital stay(LOS), surgical site infections(SSI), bile duct(BD)-injury/obstruction/leak, pain, 30-day complications, readmissions, reoperations, mortality.
RESULTS: The analysis included 31 studies: 1 prospective, 15 database, and 15 retrospective cohort studies. Compared to Lap, RAS had 49% lower conversions(OR=0.51[0.33;0.79],p<0.01), and lower EBL by an average of 7.65mL(WMD=-7.65[-13.74;-1.56],p=0.01), but longer operative-time by 9.81min(WMD=9.81[4.41;15.2],p<0.01). Both approaches had similar rates of blood transfusions, BD-injury/leak/obstruction, SSI, LOS, 30-day postoperative complication, reoperation, readmission and mortality rates. For elective cholecystectomy, RAS had 89% lower conversions(OR=0.11[0.04;0.32],p<0.01), 52% lower 30-day readmissions(OR=0.48[0.24;0.97],p=0.04), and lower EBL of 14.3 mL(WMD=-14.3[-22.14;-6.46],p<0.01), but longer operative-times by an average of 10.37 minutes(WMD=10.37[1.59;19.14],p=0.02). For emergent cholecystectomies, RAS had 43% lower conversion rates(OR=0.57[0.52;0.63],p<0.01) and lower EBL by an average of 10.6 mL(WMD=-10.64[18.16;-3.12],p<0.01) with other outcomes being similar between the two approaches.Compared to open, RAS had 72% lower likelihood of SSI(OR=0.28[0.20;0.40],p<0.01), a 60% reduced likelihood of needing blood transfusions(OR=0.40[0.22;0.74],p<0.01), a 45% lower risk of 30-day postoperative complication(OR=0.55[0.46;0.66],p<0.01), a 55% lower likelihood of 30-day mortality(OR=0.45[0.34;0.60 ],p<0.01) and a shorter LOS by an average of 3.5 days(WMD=-3.51[-4.49;-2.53 ],p<0.01). Both RAS and open had similar BD-injury, 30-day reoperation and readmission rates. There were insufficient studies for other outcomes.
CONCLUSIONS: The RAS da Vinci system is a safe and effective choice for cholecystitis, with improved outcomes that may outweigh its longer operative time. It shows promise for treating complex cases, though further high-quality evidence is needed to confirm these findings.