What question did this study set out to answer?

This review aims to assess the safety and efficacy of open, laparoscopic, and robotic cholecystectomy techniques, especially in relation to income levels of countries.

April 5, 2026Open Access

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

Key Points

This review aims to assess the safety and efficacy of open, laparoscopic, and robotic cholecystectomy techniques, especially in relation to income levels of countries.
Conducted a systematic review and meta-analysis of randomized and observational studies.
Included data from 85 studies involving over 7.5 million patients.
Utilized random-effects models for estimating risk ratios and mean differences.
Applied meta-regression to evaluate the impact of World Bank income classifications on outcomes.
Laparoscopic cholecystectomy significantly reduced mortality (RR 0.16) and complications (RR 0.46) versus open surgery.
Laparoscopic techniques led to a shorter length of stay (-4.08 days) compared to open surgery.
Robotic surgery did not demonstrate significant clinical benefits over laparoscopic surgery.
The mortality reduction from laparoscopic surgery was more pronounced in low- and middle-income countries.

Abstract

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.

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