Robotic cholecystectomy using da Vinci SP, single-site, and multiport systems: a systematic review and comparative meta-analysis

Robotic platform names do not specify operative access or instrumentation. We compared da Vinci SP, Single-Site, and multiport cholecystectomy, prioritizing total operative time and planned-access completion failure. Five databases were searched in August 2026, with Scopus rerun on 6 October 2026. A registered review underwent outcome-specific, publication-based adjudication. Direct robot-to-robot mean differences were synthesized using restricted maximum likelihood (REML) and modified Hartung-Knapp confidence intervals (CIs). Single-incision laparoscopic cholecystectomy (SILC) comparisons were ancillary; historical indirect calculations were confined to a supplementary audit. Fourteen reports were included; nine supplied extractable direct data from analysis samples totaling 1,542 participants. For SP versus Single-Site, total operative time was very uncertain (4 studies; 580 participants; mean difference [MD] - 12.49 min; 95% CI - 36.50 to 11.53; I² = 91.0%), including one conditionally reconstructed mean. The full planned-access completion-failure composite was not estimable. Console time was secondary (4 studies; 580 participants; MD - 11.40 min; modified Hartung-Knapp 95% CI - 25.35 to 2.56; I² = 80.4%; approximate 95% prediction interval - 49.03 to 26.24). Its conventional REML-Wald CI excluded zero (- 19.43 to - 3.36), but the small-study-adjusted interval did not. Rare-event safety, long-term hernia, cost-effectiveness, and platform-specific workload evidence were insufficient. The evidence is very uncertain about differences in total operative and console time between da Vinci SP and Single-Site cholecystectomy. An overall operative-time advantage or comparative safety equivalence has not been established. The evidence does not isolate the causal effects of incision count and articulation.Review registration: PROSPERO CRD420261475321.