Comparison Between Open, Laparoscopic, and robotic Cholecystectomy: a Systematic Review and Meta-Analysis

Background:We aimed to compare these approaches and examine how country income levels modify 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.Crucially, 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.