Abstract
<title>Abstract</title> <p>Robotic surgery is increasingly used in emergency general surgery, but comparative evidence with laparoscopy remains limited. This meta-analysis evaluated perioperative outcomes of robotic-assisted versus laparoscopic emergency surgery. Five databases were searched for comparative studies published between January 2015 and August 2025. Adult patients undergoing emergency appendectomy, cholecystectomy, incarcerated hernia repair, or diverticulitis resection were included. The primary outcome was conversion to open surgery. Secondary outcomes included operative time, length of stay, postoperative complications, 30-day readmission, and hospital costs. Risk of bias was assessed using the Newcastle–Ottawa Scale, and certainty of evidence using GRADE. Nine studies (177,826 patients) were included. Robotic surgery was associated with lower odds of conversion to open surgery (OR 0.39, 95% CI 0.24–0.63), but no significant differences were observed for operative time, length of stay, readmissions, or costs. Postoperative complications could not be pooled due to inconsistent reporting. Evidence certainty was low to very low, with substantial heterogeneity. Robotic emergency surgery may reduce conversion to open surgery. However, current evidence is limited by observational data and heterogeneity. High-quality prospective studies are needed in the future with standardised reporting of complications, severity grading, and cost-effectiveness outcome. No external funding was obtained for this study. The study protocol was registered with PROSPERO (CRD420251088331).</p>