Authors' objectives: Evaluate the comparative effectiveness, safety, and cost of robotic surgery compared to laparoscopic surgery for cholecystectomy.

Authors' results and conclusions: ▪ Robot-assisted cholecystectomy has been compared to laparoscopic cholecystectomy in numerous cohort studies plus a handful of randomized controlled trials (RCTs). The RCTs alone did not provide sufficient evidence for conclusions about the comparative safety and effectiveness of the two procedures. Data from these studies have been analyzed in multiple systematic reviews. Evidence tables in this report include the results of reviews published in the last five years. ▪ For most clinical outcomes, there was no significant difference between robotic cholecystectomy and laparoscopic chole-cystectomy. However, incisional hernia rates were significantly higher with robotic cholecystectomy. Some individual reviews favored robotic cholecystectomy on adverse events and need for conversion to an open procedure, but other reviews did not find those results to be statistically significant. The strength of this evidence base was graded as low to moderate. ▪ Robotic cholecystectomy was significantly more time-consuming than laparoscopic cholecystectomy. There is too much heterogeneity in reported results to allow a precise estimate of time differences. The time difference may be smaller when robotic cholecystectomy is compared to single-incision laparoscopic cholecystectomy. ▪ Robotic cholecystectomy was significantly more costly than laparoscopic cholecystectomy. There was too much hetero-geneity in reported results to allow a precise estimate of cost differences. A cost-effectiveness analysis found robotic cholecystectomy to yield a very small improvement in outcomes with an incremental cost-effectiveness ratio of $1.8 million per quality-adjusted life year compared to laparoscopic cholecystectomy. ▪ Additional evidence may allow for more definitive conclusions in the future.

Project Status: Completed

Year Published: 2024

URL for published report: https://www.med.upenn.edu/CEP/external-request-form.html

Requestor: supply chain, new technology committee

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: United States

Organisation Name: Penn Medicine Center for Evidence-based Practice

Contact Address: Penn Medicine Center for Evidence-based Practice, University of Pennsylvania Health System, 3600 Civic Center Blvd, 3rd Floor West, Philadelphia PA 19104

Contact Name: Nikhil Mull

Contact Email: cep@pennmedicine.upenn.edu

Copyright: <p>Center for Evidence-based Practice (CEP)</p>