Robotic vs laparoscopic left colectomy: a meta-analysis of over 70 000 patients across 24 trials

Background: Robotic platforms have slightly impacted minimally invasive surgery, although the extent of their superiority over conventional laparoscopy for left colectomy remains ambiguous. Robotic-assisted left colectomy (RLC) is increasingly utilized for the management of colorectal illnesses; nonetheless, there remains debate regarding its superiority over laparoscopic left colectomy (LLC). This meta-analysis integrates data from 24 studies, including over 70 000 people, to provide a comprehensive overview of the outcome disparities pre- and post-surgery. Methods: We conducted a comprehensive search of PubMed, Scopus, Web of Science, and Cochrane from 2004 to April 2025 to identify studies comparing RLC vs. LLC in adults. We utilized RevMan 5.4 to amalgamate the data. We employed random-effects models to determine the risk ratios (RRs) and mean differences (MDs). Sensitivity analysis was conducted to evaluate the robustness of the results amid increased heterogeneity. Results: A total of 24 investigations were conducted. RLC significantly reduced the likelihood of requiring open surgery (RR 0.53), experiencing postoperative complications (RR 0.87), encountering an anastomotic leak (RR 0.84), developing a superficial wound infection (RR 0.79), and necessitating additional surgery. The results were significantly more robust when high-variance trials were excluded from the sensitivity analysis. The duration of the procedure was significantly extended with RLC (MD + 40 minutes), although there were no changes in mortality (RR 1.26; P = 0.07) or hemorrhage (RR 1.00). No significant changes were observed in Clavien–Dindo >2 complications or stoma formation. Subgroup analysis was done for more robust findings. The asymmetry observed in the funnel plot suggests the potential existence of publication bias for certain outcomes. Conclusion: RLC demonstrates modest yet clinically significant advantages compared to LLC, particularly in reducing the incidence of surgical conversions and sequelae. These findings advocate for its application in a select group of patients, considering the duration of the treatment and the institution’s resources.