Single-port robotic versus single-incision laparoscopic cholecystectomy in patients with BMI ≥ 25 kg/m2: a systematic review and meta-analysis.

Abstract

Previous studies have compared single-port robotic cholecystectomy (SPRC) to single-incision laparoscopic (SILC). However, there is not a systematic review and meta-analysis in patient with BMI ≥ 25 kg/m² even though higher BMI is a risk factor for gallstone disease, a common indication for cholecystectomy. PubMed, Scopus and Cochrane Library were searched for related literature. Studies and data were extracted by two independent reviewers. Inverse variances weighted mean differences (WMD) with random effects model were used for continues values and odds ratios (OR) with random effects model using the Mantel-Haenszel's formula were used for dichotomous value. Heterogeneity using Higgins I² and p values were calculated. Sensitivity analysis was performed for operative duration and intraoperative complications. In this meta-analysis, six studies involving a total of 734 patients examined SPRC and SILC. The analysis revealed a statistically significant increase in operative duration for SPRC compared to SILC, with a weighted mean difference of 26.67 min (95% CI 14.99, 38.34; I² = 93%; P_{heterogeneity} < 0.00001; P_overall < 0.00001). Regarding conversion to multi-port cholecystectomy (MC), no statistically significant difference was found, yielding an odds ratio of 0.94 (95% CI 0.36, 2.45; I² = 0%; P_{heterogeneity} = 0.78; P_overall = 0.89). Intra-operative blood loss showed non-significant differences, with a weighted mean difference of - 16.76 ml (95% CI - 48.56, 15.03; I² = 78%; P_{heterogeneity} = 0.03; P_overall = 0.30). Length of hospitalization was significantly reduced by approximately half a day for SPRC compared to SILC, with a weighted mean difference of - 0.52 days (95% CI - 0.89, - 0.14; I² = 0%; P_{heterogeneity} = 0.52; P_overall = 0.007). Intra-operative complications did not differ significantly between the techniques, resulting in an odds ratio of 0.59 (95% CI 0.19, 1.81; I² = 70%; P_{heterogeneity} = 0.04; P_overall = 0.36). Finally, two studies evaluated bile leak rates, concluding no significant difference with an odds ratio of 0.86 (95% CI 0.39, 1.88; I² = 23%; P_{heterogeneity} = 0.25; P_overall = 0.70). Sensitivity analyses indicated that no single study unduly influenced the results for operative duration, while one study was identified as a source of heterogeneity in intra-operative complications. SPRC is associated with longer operative duration, but shorter length of hospitalization in patients with BMI ≥ 25 kg/m², compared to laparoscopic. Future studies should aim to examine incisional hernias rates as well as determine the long-term outcomes. PROSPERO registration: CRD42024602514.