Robotic Versus Laparoscopic Cholecystectomy in Acute Cholecystitis: An Umbrella Review of Comparative Evidence and Severity-Related Gaps

Background Robotic-assisted cholecystectomy (RC) is increasingly used for acute cholecystitis, but comparative evidence versus laparoscopic cholecystectomy (LC) remains limited. This systematic review synthesizes current evidence from systematic reviews and meta-analyses, focusing on conversion rates, safety outcomes, operative efficiency, and the influence of surgeon experience and institutional volume. Methods A systematic search of PubMed, Scopus, Web of Science, and Cochrane Library (2015–2026) identified systematic reviews and meta-analyses comparing RC and LC in acute cholecystitis. Qualitative synthesis focused on primary outcomes (conversion to open surgery, bile duct injury, postoperative complications) and secondary outcomes (operative time, hospital length of stay, and volume–outcome relationships). Risk of bias and methodological quality were assessed following PRISMA 2020 guidelines [Page et al., 2021]. Results Three systematic reviews/meta-analyses met inclusion criteria [Singh et al., 2024; Kane et al., 2020; Mullens et al., 2025]. RC may reduce conversion rates to open surgery compared to LC, although differences are largely influenced by surgeon experience and patient selection. Safety outcomes, including bile duct injury and postoperative complications, are comparable between RC and LC [Singh et al., 2024; Kane et al., 2020]. RC is associated with slightly longer operative times, mainly due to robotic setup. High-volume centers achieve superior outcomes, regardless of surgical approach [Mullens et al., 2025]. Severity-stratified analysis using Tokyo Guidelines (Grade II–III) was not possible due to insufficient data [Yokoe et al., 2018]. Conclusions Current evidence does not support routine use of RC for acute cholecystitis. Laparoscopic cholecystectomy remains the standard of care. RC may be considered selectively in complex cases at high-volume, experienced centers. Prospective, severity-stratified trials are needed to clarify potential advantages and cost-effectiveness of RC in acute settings.