Systematic review and meta-analysis of robotic versus laparoscopic radical cholecystectomy for gallbladder cancer.

Background: Robotic surgery for gallbladder cancer (GBC) has been on the uptake in the past few years, but few studies have studied oncological outcomes and safety. Robotic radical cholecystectomy (RRC) is a highly complex procedure requiring experienced surgeons and is associated with high morbidity and need for prolonged hospitalisation. Hence, the aim of this systematic review and meta-analysis was to compare between surgical outcomes and long-term survival for robotic radical resection versus laparoscopic radical resection for GBC. Methods: PubMed, Ovid Cochrane Library, Medline and Embase were searched with the relevant keywords including laparoscopic and robotic radical cholecystectomy. Relevant studies were analysed both qualitatively and quantitative, and a meta-analysis was performed on selected data. Results: A total of 2,790 papers were screened, with 169 papers selected for full text review. A total of 11 studies met the eligibility criteria with a total of 263 patients undergoing laparoscopic radical resection and 52 patients undergoing robotic radical resection for GBC. Compared to laparoscopic radical cholecystectomy (LRC), RRC has shown to have adequate lymph node yield, no difference in mortality and morbidity rate, no difference in inpatient stays and no difference in overall recurrence rate. No anastomotic leak was reported in the robotic arm, as compared to 13 patients in the laparoscopic arm whose operation was complicated by bile leakage. Conclusions: Robotic surgery can be safely carried out in radical cholecystectomy with adequate resection margins and facilitate early recovery. It can also help to mitigate the risk of postoperative complications such as bile leakage.