Totally robotic low anterior resection versus conventional laparoscopic surgery for rectal cancer: a systematic review and meta-analysis.

Totally robotic low anterior resection (TR-LAR) has not been consistently compared with conventional laparoscopic low anterior resection (L-LAR), as previous studies often combined hybrid and fully robotic techniques. This limits the ability to assess the true impact of a completely robotic approach. Therefore, a focused evaluation of TR-LAR versus L-LAR is warranted. A PRISMA-guided systematic review and meta-analysis of studies comparing totally robotic versus laparoscopic LAR was performed. Random-effects models were used to pool outcomes, with heterogeneity assessed by I² and evidence evaluated using ROBINS-I and GRADE. The review included five studies. Total robotic low anterior resection was associated with longer operative time (mean difference 43.2 min; p = 0.008) and a lower conversion to open surgery rate (-20% ; p = 0.02) than laparoscopic low anterior resection. There were no significant differences in estimated blood loss (13.3 mL lower; p = 0.65), overall complications (16% higher odds; p = 0.56), major complications (19% higher odds; p = 0.59), anastomotic leakage (1% lower odds; p = 0.99), postoperative ileus (197% higher odds; p = 0.21), length of hospital stay (1.1 days longer; p = 0.09), positive circumferential resection margin (32% lower odds; p = 0.47), lymph node yield (1.3 additional lymph nodes; p = 0.52), completeness of total mesorectal excision (67% higher odds; p = 0.42), or diverting ileostomy rate (62% lower odds; p = 0.47). Completely robotic LAR is linked to reduced conversion rates but extended operating duration in comparison to laparoscopic LAR, but other perioperative and oncological results seem similar. The evidence certainty is low to very low, necessitating additional high-quality research to elucidate the potential benefits of a totally robotic approach.