fig1

Figure 1. PRISMA flow diagram. Systematic review and meta-analysis study selection process. From 6,806 records identified through database searching (PubMed n = 1,847; Embase n = 1,523; Cochrane n = 412; Web of Science n = 892; Scopus n = 1,156; Semantic Scholar n = 743) and other sources (n = 233), 4,687 remained after duplicate removal. Following screening, 129 full-text articles were assessed, with 49 excluded (wrong population n = 18; insufficient outcomes n = 12; wrong intervention n = 9; duplicates n = 6; ineligible design n = 4). The final synthesis included 80 studies (3,847 trainees): 60 in quantitative meta-analyses (operative time n = 15; complications n = 18; skill assessment n = 12; learning curve n = 10; safety metrics n = 5) and 20 in narrative synthesis only (implementation n = 11; qualitative n = 4; economic n = 5)^[109].