Minimally Invasive Versus Conventional Colectomy: Evaluating Clinical Outcomes, Complications, and Recovery in Modern Surgical Practice

Minimally invasive colectomy (MIC) has transformed colorectal surgery by improving recovery, reducing morbidity, and enhancing postoperative quality of life, yet variations in clinical outcomes, learning curves, and cost-effectiveness continue to challenge universal adoption. This systematic review synthesized current evidence comparing MIC and open colectomy (OC) across clinical, functional, and economic outcomes, following PRISMA 2020 guidelines. A structured search of PubMed, Embase, Scopus, Web of Science, and CENTRAL identified randomized controlled trials, multicenter cohorts, and meta-analyses published between 2015 and 2025. Studies were included only if they compared MIC and OC in adults (≥18 years) and reported extractable quantitative outcomes. Across eligible studies, MIC demonstrated a mean reduction in hospital length of stay (LOS) of approximately two to three days, an effect size ranging from 0.45 to 0.62 for postoperative morbidity reduction, and a 40-60% decrease in intraoperative blood loss, while maintaining comparable oncologic parameters to OC. Integration with Enhanced Recovery After Surgery (ERAS) protocols further improved bowel recovery, mobilization, and discharge timelines without increasing complications. Risk-of-bias assessments using Cochrane RoB 2.0 and the Newcastle-Ottawa Scale indicated predominantly low-risk evidence, strengthening confidence in the findings. Inclusion of elderly and emergency populations demonstrated that MIC remains safe and reproducible across complex settings. Although robotic colectomy increases operative time and cost, these drawbacks are offset by accelerated recovery and reduced readmissions. Collectively, the quantitatively reinforced evidence supports the growing role of MIC, particularly when combined with ERAS principles, as an efficient and patient-centered approach in modern colorectal practice.