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Robotic-assisted cholecystectomy versus conventional laparoscopic cholecystectomy for benign gallbladder disease: a systematic review and meta-analysis

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Abstract

Laparoscopic cholecystectomy (LC) is the established gold standard treatment for benign gallbladder diseases. However, robotic cholecystectomy is still controversial. Therefore, we aimed to compare intraoperative and postoperative outcomes in LC and robotic-assisted cholecystectomy (RAC) in patients with nonmalignant gallbladder conditions. PubMed, Scopus, Cochrane Library, and Web of Science were systematically searched for studies comparing RAC to LC in patients with benign gallbladder disease. Only randomized trials and non-randomized studies with propensity score matching were included. Mean differences (MDs) were computed for continuous outcomes and odds ratios (ORs) for binary endpoints, with 95% confidence intervals (CIs). Heterogeneity was assessed with I2 statistics. Statistical analysis was performed using Software R, version 4.2.3. A total of 13 studies comprising 22,440 patients were included, of whom 10,758 patients (47.94%) underwent RAC. The mean age was 48.5 years and 65.2% were female. Compared with LC, RAC significantly increased operative time (MD 12.59 min; 95% CI 5.62–19.55; p < 0.01; I2 = 79%). However, there were no significant differences between the groups in hospitalization time (MD -0.18 days; 95% CI − 0.43–0.07; p = 0.07; I2 = 89%), occurrence of intraoperative complications (OR 0.66; 95% CI 0.38–1.15; p = 0.14; I2 = 35%) and bile duct injury (OR 0.99; 95% CI 0.64, 1.55; p = 0.97; I2 = 0%). RAC was associated with an increase in operative time compared with LC without increasing hospitalization time or the incidence of intraoperative complications. These findings suggest that RAC is a safe approach to benign gallbladder disease.

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Data availability

The authors confirm that the data supporting the findings of this study are available within the article and its Supplementary Materials.

Abbreviations

PRISMA:

Preferred reporting items for systematic reviews and meta-analyses

PROSPERO:

International prospective register of systematic reviews

GRADE:

Grading of recommendations assessment, development and evaluation

RCT:

Randomized controlled trial

OR:

Odds ratio

MD:

Mean difference

RAC:

Robotic-assisted laparoscopic cholecystectomy

LC:

Laparoscopic cholecystectomy

PSM:

Propensity score matching

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Contributions

Conceptualization: Lucas Monteiro Delgado, Bernardo Fontel Pompeu, M.D, Sergio Mazzola Poli de Figueiredo, MD; Methodology: Lucas Monteiro Delgado, Bernardo Fontel Pompeu, M.D, Eric Pasqualotto, Sergio Mazzola Poli de Figueiredo, MD, Caio Mendonça Magalhães, Ana Flávia Machado Oliveira, MD, Bárbara Klyslie Kato; Luis Fernando Paes Leme, MD.; Formal analysis and investigation: Lucas Monteiro Delgado, Bernardo Fontel Pompeu, M.D, Caio Mendonça Magalhães, Eric Pasqualotto; Writing—original draft preparation: Lucas Monteiro Delgado, Bernardo Fontel Pompeu, M.D, Eric Pasqualotto, Sergio Mazzola Poli de Figueiredo, MD, Caio Mendonça Magalhães, Ana Flávia Machado Oliveira, MD, Bárbara Klyslie Kato; Luis Fernando Paes Leme, MD. Writing—review and editing: Eric Pasqualotto, Sergio Mazzola Poli de Figueiredo, MD, Bernardo Fontel Pompeu, M.D, Lucas Monteiro Delgado, Caio Mendonça Magalhães, Ana Flávia Machado Oliveira, MD, Bárbara Klyslie Kato; Luis Fernando Paes Leme, MD; Supervision: Bernardo Fontel Pompeu, M.D, Sergio Mazzola Poli de Figueiredo, MD, Luis Fernando Paes Leme, MD.

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Delgado, L.M., Pompeu, B.F., Pasqualotto, E. et al. Robotic-assisted cholecystectomy versus conventional laparoscopic cholecystectomy for benign gallbladder disease: a systematic review and meta-analysis. J Robotic Surg 18, 242 (2024). https://doi.org/10.1007/s11701-024-01989-5

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