<p>The focus of this comprehensive review and meta-analysis is to evaluate both the efficacy and safety of robot-assisted radical cystectomy (RARC) versus open radical cystectomy (ORC) in treating bladder cancer among elderly patients. A rigorous review of literature utilized several key databases—Google Scholar, the Cochrane Library, EMBASE, PubMed, and the Web of Science, complete with updates through July 2024. The data were analyzed using Stata 18, employing a random-effects model for the analysis. In this analysis, five studies were analyzed. Initial comparisons revealed that age, body mass index (BMI), and pT3 staging were consistent across both groups, with gender being the only exception showing variation. The results demonstrated that patients undergoing robot-assisted cystectomy had reduced estimated blood loss, decreased duration of hospitalization, and fewer instances of positive surgical margins. The analysis found no notable statistical discrepancies in operative durations between the two groups, transfusion rate, overall complications, minor complications, major complications, or lymph node positivity rates. In terms of urinary diversion, ileal conduit was more common in the RARC group, while ureterocutaneostomy was more frequently observed in the ORC group. However, no significant differences were found between the two groups regarding the use of orthotopic neobladder. RARC offers a viable and secure approach for surgical treatment in elderly patients with bladder cancer, showing potential enhancements in crucial areas such as reduced estimated blood loss and shorter durations of hospitalization.</p>