TPT 8.12 Robotic Approach for Nonelective Cholecystectomies is Associated with More Postoperative Complications than Laparoscopic Approaches: A Systematic Review and Meta-Analysis

Abstract

Robotic cholecystectomy (RC) is increasingly utilised for elective pathology, but its safety and efficacy acutely remain debated compared to the gold-standard laparoscopic cholecystectomy (LC). This study aims to compare the clinical outcomes of RC versus LC for patients undergoing non-elective (hot/emergency) cholecystectomy. Standard medical databases MEDLINE, Embase, Pubmed and Cochrane Library were searched to find studies comparing RC versus LC for nonelective cholecystectomy. Statistical analysis was performed using Review Manager Software 5.4, and the meta-analysis was performed with the random effects model analysis. Eleven studies meeting inclusion criteria were identified, comprising a total of 1,200,338 patients. In the random effects model analysis, the robotic approach was associated with statistically significantly higher odds of postoperative complications (Odds ratio [OR]: 2.06; 95% confidence interval [CI 1.40, 3.05]; z=3.65, p=0.0003). However, RC and LC demonstrated no significant difference regarding conversion to open surgery (OR: 0.76; 95% [CI 0.42, 1.37]; z=0.94, p=0.35), operative time (Standardised mean difference [SMD] -0.03; 95% [CI -0.18, 0.11]; z=0.45, p=0.65), hospital length of stay (SMD 0.01; 95% [CI -0.07, 0.09]; z=0.17, p=0.86), intraoperative complications (OR 0.96; 95% [CI 0.77, 1.20]; z=0.35, p=0.73), or 30-day readmission (OR 1.09; 95% [CI 0.98, 1.21]; z=1.55, p=0.12). RC for nonelective cholecystectomy appears feasible, with operative times, conversion rates, and hospital stay comparable to the laparoscopic approach. However, the higher odds of postoperative complications in the robotic group warrant caution. Patient selection and consideration of resource utilisation are essential when applying the robotic platform in the acute setting.