Comparison of da Vinci Robotic Cholecystectomy and Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis of Postoperative Outcomes and Cost-Effectiveness.

Robotic cholecystectomy (RC) using the da Vinci surgical system has been introduced as a potential alternative to the gold standard laparoscopic cholecystectomy (LC) for gallbladder removal. This systematic review aims to evaluate and compare the postoperative outcomes (operative time, bile leak, and postoperative complications) and cost-effectiveness between da Vinci RC and LC. A comprehensive search of electronic databases, including EMBASE, MEDLINE, Cochrane Library, and PubMed, used Medical Subject Headings terms and Boolean operators to identify relevant studies. Comparative trials assessing postoperative outcomes and costs between RC and LC were included. Data were extracted independently by researchers and analyzed using the RevMan 5.4 software (The Cochrane Collaboration, London, UK). The analysis included six studies with a total of 1,013 patients, comprising three randomized controlled trials (RCTs) and three cohorts conducted across Switzerland, Taiwan, the USA, and Italy. Results showed that LC had a significantly shorter operation duration than RC (standardized mean difference: 0.27; 95% CI, 0.05-0.49; p = 0.01). No significant differences were observed between RC and LC in terms of bile leak rates (odds ratio, 0.37; 95% CI, 0.06-2.21; p = 0.27) or postoperative complications (odds ratio, 0.50; 95% CI, 0.18-1.37; p = 0.18). Cost analysis revealed that RC was more cost-effective than LC (standardized mean difference, 3.16; 95% CI, 0.39-5.93; p = 0.03), with substantial heterogeneity noted among the studies. The findings suggest that RC does not provide significant clinical advantages over LC in postoperative outcomes and incurs higher costs. Due to the heterogeneity and the limited number of RCTs included, a major multicenter RCT is recommended to validate these results further. In conclusion, LC remains the preferred approach due to its shorter operative time and cost-effectiveness, with no significant differences in clinical outcomes compared to da Vinci RC. Further research with larger, multicenter trials is warranted to confirm these findings and guide clinical decision-making.
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