Robotic Versus Laparoscopic Cholecystectomy in Acute Cholecystitis: A Review of Comparative Evidence and Severity-Related Gaps

Robotic Versus Laparoscopic Cholecystectomy in Acute Cholecystitis: A Review of Comparative Evidence and Severity-Related Gaps | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Robotic Versus Laparoscopic Cholecystectomy in Acute Cholecystitis: A Review of Comparative Evidence and Severity-Related Gaps Safana Abdullah Algutaini, Saleh Al_wageeh This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8937350/v2 This work is licensed under a CC BY 4.0 License Status: Posted Version 2 posted You are reading this latest preprint version Show more versions Abstract Background Robotic-assisted cholecystectomy (RC) is increasingly used for acute cholecystitis, but comparative evidence versus laparoscopic cholecystectomy (LC) remains limited. This systematic review synthesizes current evidence from systematic reviews and meta-analyses, focusing on conversion rates, safety outcomes, operative efficiency, and the influence of surgeon experience and institutional volume. Methods A systematic search of PubMed, Scopus, Web of Science, and Cochrane Library (2015–2026) identified systematic reviews and meta-analyses comparing RC and LC in acute cholecystitis. Qualitative synthesis focused on primary outcomes (conversion to open surgery, bile duct injury, postoperative complications) and secondary outcomes (operative time, hospital length of stay, and volume–outcome relationships). Risk of bias and methodological quality were assessed following PRISMA 2020 guidelines [Page et al., 2021 ]. Results Three systematic reviews/meta-analyses met inclusion criteria [Singh et al., 2024 ; Kane et al., 2020 ; Mullens et al., 2025 ]. RC may reduce conversion rates to open surgery compared to LC, although differences are largely influenced by surgeon experience and patient selection. Safety outcomes, including bile duct injury and postoperative complications, are comparable between RC and LC [Singh et al., 2024 ; Kane et al., 2020 ]. RC is associated with slightly longer operative times, mainly due to robotic setup. High-volume centers achieve superior outcomes, regardless of surgical approach [Mullens et al., 2025 ]. Severity-stratified analysis using Tokyo Guidelines (Grade II–III) was not possible due to insufficient data [Yokoe et al., 2018 ]. Conclusions Current evidence does not support routine use of RC for acute cholecystitis. Laparoscopic cholecystectomy remains the standard of care. RC may be considered selectively in complex cases at high-volume, experienced centers. Prospective, severity-stratified trials are needed to clarify potential advantages and cost-effectiveness of RC in acute settings. Robotic surgery laparoscopic surgery cholecystectomy acute cholecystitis systematic review Tokyo Guidelines Full Text Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 2 posted You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8937350","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":597077676,"identity":"377a83f8-d090-4f3d-bee9-18e19d5a9ef6","order_by":0,"name":"Safana Abdullah Algutaini","email":"data:image/png;base64,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","orcid":"https://orcid.org/0009-0004-8854-974X","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Safana","middleName":"Abdullah","lastName":"Algutaini","suffix":""},{"id":597077677,"identity":"a741bcb2-19c0-4b1d-abca-0db67f876783","order_by":1,"name":"Saleh Al_wageeh","email":"","orcid":"","institution":"Ibb University","correspondingAuthor":false,"prefix":"","firstName":"Saleh","middleName":"","lastName":"Al_wageeh","suffix":""}],"badges":[],"createdAt":"2026-02-22 06:47:46","currentVersionCode":2,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-8937350/v2","doiUrl":"https://doi.org/10.21203/rs.3.rs-8937350/v2","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105563355,"identity":"74f35dad-3296-449f-92f1-40dcfdf0e55e","added_by":"auto","created_at":"2026-03-27 12:46:46","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":234864,"visible":true,"origin":"","legend":"","description":"","filename":"FinalRSandLS.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8937350/v2_covered_f4c8b9fc-3a16-4590-b4df-2768d83250d5.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eRobotic Versus Laparoscopic Cholecystectomy in Acute Cholecystitis: A Review of Comparative Evidence and Severity-Related Gaps\u003c/p\u003e","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"East Carolina University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Robotic surgery, laparoscopic surgery, cholecystectomy, acute cholecystitis, systematic review, Tokyo Guidelines","lastPublishedDoi":"10.21203/rs.3.rs-8937350/v2","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8937350/v2","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eRobotic-assisted cholecystectomy (RC) is increasingly used for acute cholecystitis, but comparative evidence versus laparoscopic cholecystectomy (LC) remains limited. This systematic review synthesizes current evidence from systematic reviews and meta-analyses, focusing on conversion rates, safety outcomes, operative efficiency, and the influence of surgeon experience and institutional volume.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA systematic search of PubMed, Scopus, Web of Science, and Cochrane Library (2015\u0026ndash;2026) identified systematic reviews and meta-analyses comparing RC and LC in acute cholecystitis. Qualitative synthesis focused on primary outcomes (conversion to open surgery, bile duct injury, postoperative complications) and secondary outcomes (operative time, hospital length of stay, and volume\u0026ndash;outcome relationships). Risk of bias and methodological quality were assessed following PRISMA 2020 guidelines [Page et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2021\u003c/span\u003e].\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThree systematic reviews/meta-analyses met inclusion criteria [Singh et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Kane et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Mullens et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2025\u003c/span\u003e]. RC may reduce conversion rates to open surgery compared to LC, although differences are largely influenced by surgeon experience and patient selection. Safety outcomes, including bile duct injury and postoperative complications, are comparable between RC and LC [Singh et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Kane et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2020\u003c/span\u003e]. RC is associated with slightly longer operative times, mainly due to robotic setup. High-volume centers achieve superior outcomes, regardless of surgical approach [Mullens et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2025\u003c/span\u003e]. Severity-stratified analysis using Tokyo Guidelines (Grade II\u0026ndash;III) was not possible due to insufficient data [Yokoe et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2018\u003c/span\u003e].\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eCurrent evidence does not support routine use of RC for acute cholecystitis. Laparoscopic cholecystectomy remains the standard of care. RC may be considered selectively in complex cases at high-volume, experienced centers. Prospective, severity-stratified trials are needed to clarify potential advantages and cost-effectiveness of RC in acute settings.\u003c/p\u003e","manuscriptTitle":"Robotic Versus Laparoscopic Cholecystectomy in Acute Cholecystitis: A Review of Comparative Evidence and Severity-Related Gaps","msid":"","msnumber":"","nonDraftVersions":[{"code":2,"date":"2026-03-20 19:51:57","doi":"10.21203/rs.3.rs-8937350/v2","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2026-02-25 17:15:14","doi":"10.21203/rs.3.rs-8937350/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f09318bf-d2c8-4ff6-b056-c86583568c75","owner":[],"postedDate":"March 20th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-25T17:15:14+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-20 19:51:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v2","identity":"rs-8937350","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8937350","identity":"rs-8937350","version":["v2"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}