Comparison between open, laparoscopic, and robotic cholecystectomy: a systematic review and meta-analysis

BACKGROUND: We aimed to compare open, laparoscopic, and robotic cholecystectomy, and examine how country income levels modify these associations. METHODS: We conducted a systematic review and meta-analysis of randomized and observational studies from major databases through November 2024. We analyzed data from 85 studies comprising over 7.5 million patients. We utilized random-effects models to estimate risk ratios (RR) and mean differences (MD), and applied meta-regression to assess the influence of World Bank income classifications. RESULTS: Laparoscopic cholecystectomy (LC) significantly reduced mortality (RR 0.16; 95% CI: 0.13-0.18), complications (RR 0.46), and length of stay (-4.08 days) versus open surgery. Robotic surgery yielded no significant clinical benefits over LC. Meta-regression revealed that the mortality benefit of LC was significantly greater in low- and middle-income countries than in high-income nations. CONCLUSIONS: LC demonstrates superior safety and efficacy compared to open techniques, especially in resource-limited settings. Based on the available evidence, no demonstrable difference in outcomes was observed between robotic and laparoscopic approaches.