SRS76 - Robotic assisted <i>versus</i> conventional laparoscopic appendectomy in adults: a systematic review and meta-analysis of postoperative complication rates

Abstract Background Laparoscopic appendectomy has largely replaced open surgery due to reduced complications and shorter recovery. Robotic-assisted surgery offers theoretical advantages such as enhanced dexterity and visualisation, but its role in appendectomy remains unclear. Methods We conducted a systematic review and meta-analysis in accordance with PRISMA 2020 guidelines (PROSPERO ID: CRD420251090156). Adult patients undergoing robotic-assisted appendectomy (RA) were compared with those undergoing laparoscopic appendectomy (LA). Outcomes included 30-day mortality, readmission, complications, conversion to open surgery, operative time, length of stay, and cost. Data were pooled using random-effects models, and certainty of evidence was assessed with GRADE. Results Three retrospective cohort studies (n ≈ 50 000 LA; n ≈ 300 RA) were included. Pooled analyses showed no significant differences between RA and LA in 30-day mortality (OR 10.0, 95% c.i. 0.00–8.6 × 10⁸) or readmission (OR 1.34, 95% c.i. 0.03–70.8), though certainty was very low. RA was associated with longer operative times (SMD 0.37, 95% c.i. 0.16–0.58; low certainty). Narrative findings suggested shorter length of stay with RA, but costs were higher, and evidence quality was very low. Complication rates appeared comparable between groups. Conclusions Robotic-assisted appendectomy is safe but offers no clear clinical advantages over laparoscopic appendectomy, apart from potentially shorter hospitalisation. Current evidence is limited by small RA sample sizes, retrospective design, and low certainty. High-quality prospective studies and cost-effectiveness analyses are needed to clarify the role of robotics in appendectomy.