*Systematic Review* **The Role of Robotic Visceral Surgery in Patients with Adhesions: A Systematic Review and Meta-Analysis**

**Marco Milone 1,\*, Michele Manigrasso <sup>2</sup> , Pietro Anoldo <sup>2</sup> , Anna D'Amore <sup>1</sup> , Ugo Elmore <sup>3</sup> , Mariano Cesare Giglio <sup>1</sup> , Gianluca Rompianesi <sup>1</sup> , Sara Vertaldi <sup>1</sup> , Roberto Ivan Troisi <sup>1</sup> , Nader K. Francis <sup>4</sup> and Giovanni Domenico De Palma <sup>1</sup>**


**Abstract:** Abdominal adhesions are a risk factor for conversion to open surgery. An advantage of robotic surgery is the lower rate of unplanned conversions. A systematic review was conducted using the terms "laparoscopic" and "robotic". Inclusion criteria were: comparative studies evaluating patients undergoing laparoscopic and robotic surgery; reporting data on conversion to open surgery for each group due to adhesions and studies including at least five patients in each group. The main outcomes were the conversion rates due to adhesions and surgeons' expertise (novice vs. expert). The meta-analysis included 70 studies from different surgical specialities with 14,329 procedures (6472 robotic and 7857 laparoscopic). The robotic approach was associated with a reduced risk of conversion (OR 1.53, 95% CI 1.12–2.10, *p* = 0.007). The analysis of the procedures performed by "expert surgeons" showed a statistically significant difference in favour of robotic surgery (OR 1.48, 95% CI 1.03–2.12, *p* = 0.03). A reduced conversion rate due to adhesions with the robotic approach was observed in patients undergoing colorectal cancer surgery (OR 2.62, 95% CI 1.20–5.72, *p* = 0.02). The robotic approach could be a valid option in patients with abdominal adhesions, especially in the subgroup of those undergoing colorectal cancer resection performed by expert surgeons.

**Keywords:** conversion; abdominal adhesions; laparoscopic surgery; robotic surgery
