No advantages to using robot-assisted laparoscopic cholecystectomy

Clinical question: 
How effective is robot-assisted laparoscopic cholecystectomy?
Bottom line: 
Compared to human-assisted laparoscopic cholecystectomy, robot assisted surgery is safe but does not offer any advantages. 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 2 of the 3 trials that reported surgeons' preference, the surgeons preferred a robot assistant to a human assistant. Based on the current available evidence, robot-assisted surgery should not replace human assistants in workforce planning.
Caveat: 
All trials were at high risk of bias. In one trial, about one-sixth of the laparoscopic cholecystectomies in which robot assistance was used, required temporary use of a human assistant. The reviewers were unable to identify trials comparing one type of robot assistant with another.
Context: 
About 10-15% of the adult Western population have gallstones¹,² and between 1% and 4% become symptomatic in a year.¹,² The role of a robotic assistant in laparoscopic cholecystectomy is controversial. 1. NIH. Gallstones and laparoscopic cholecystectomy. 1992. http://consensus.nih.gov/1992/1992GallstonesLaparoscopy 090html.htm. 2. Halldestam I et al. Brit J Surg 2004;91:734-38.
Review CD#: 
CD006578
PEARLS No: 
193
Date: 
August, 2009
Authored by: 
Brian R McAvoy