Robot-assisted laparoscopic cholecystectomy appears safe but does not offer any advantage over human-assisted laparoscopic cholecystectomy

The role of a robotic assistant in laparoscopic cholecystectomy (removal of gallbladder by key-hole surgery) is controversial. In this systematic review comparing robot assistants with human assistants for laparoscopic cholecystectomy, we included five randomised clinical trials including 453 patients: 159 to the robot assistant group and 165 to the human assistant group (one trial report including 129 patients was a conference abstract and did not state the number of patients in each group). All the trials were of high risk of bias. There was no statistically significant difference between the two groups for morbidity, conversion to open cholecystectomy, total operating time, or hospital stay. The instrument set-up time was significantly lower in the human assistant group. In one trial, about one sixth of the laparoscopic cholecystectomies in which robot assistant was used, required temporary use of a human assistant. It appears that there was little or no requirement for human assistants in the other three published trials. In two of the three trials, which reported surgeons' preference, the surgeons preferred a robot assistant to a human assistant. Although robot-assisted laparoscopic cholecystectomy appears safe, there are no significant advantages over human-assisted laparoscopic cholecystectomy. Further randomised trials with low risk of bias (systematic errors) and low risk of play of chance (random errors) are needed.