Single-site robotic cholecystectomy versus multi-port laparoscopic cholecystectomy: A systematic review and meta-analysis.

OBJECTIVE: To investigate the outcomes of single-site robotic cholecystectomy (SSRC) compared to multi-port laparoscopic cholecystectomy (MLC), evaluate the safety and feasibility of SSRC.

METHODS: To find relevant studies, the electronic databases PubMed, MEDLINE, The Cochrane Library, and EMBASE were used to seek information in English literature from 2011 to 2017. Studies comparing SSRC to MLC, for any indication, were included in the analysis. This systematic review and meta-analysis was performed with RevMan Version 5.3.

RESULTS: Seven studies (two randomized control trails (RCTs) and five comparative studies, n = 1657 patients) were included in our analysis. The data showed that the SSRC and MLC had equivalent outcomes for operative time (MD = -3.06, 95% CI: -7.61-1.49, p = 0.19), bleeding (OR = 1.63, 95%CI: 0.40-6.56, p = 0.49), postoperative complications (OR = 1.11, 95%CI: 0.35-3.51, p = 0.86), bile leakage (OR = 0.38, 95%CI: 0.07-2.00, p = 0.26), wound infection (OR = 1.92, 95%CI: 0.86-4.32, p = 0.11), conversion rate (OR = 1.30, 95% CI: 0.71-2.37, p = 0.40), and hospital stay (MD = -0.02, 95% CI: -0.60-0.57, p = 0.96). However, in the SSRC group the risk of incisional hernia is higher than the MLC group (OR = 4.23, 95% CI: 1.87-9.58, p = 0.0005), incidence of incisional hernia rate in SSRC group is higher than MLC group (5.8% vs. 0.9%), and the total costs in the SSRC group is higher than MLC group (MD = 3.51, 95% CI: 0.31-6.71, p = 0.03).

CONCLUSIONS: The medical cost is significantly higher in SSRC compared with MLC, and SSRC can increasing the risk of incisional hernia. Therefore, surgeons must be carefully balanced its advantage, disadvantage and risk.