Article Title: Comparative Safety of Robotic-Assisted vs Laparoscopic Cholecystectomy

Journal Title: The Journal of the American Medical Association

Publication Year: 2023

Author(s): Kalata, S., et al.

 

Study Description: Cholecystectomy is a common routine operation performed by general surgeons across the country. There is debate as to whether robotic assisted cholecystectomy is safer for patients compared to laparoscopic cholecystectomy. Recently, the use of robotic assisted surgical procedures has spiked, with an increased 37 fold from 211 to 147,341 patients in 2010 compared to 2019. There is debate regarding safety implications due to these newer changes in practice with increased use of robotic surgeries. This retrospective cohort study includes Medicare beneficiaries age 66 to 99 who underwent cholecystectomy from 2010 to 2019.

 

Outcomes: The primary outcome studied was the rate of bile duct injury that required definitive surgical reconstruction within 1 year after the cholecystectomy. Secondary outcomes include bile duct injury requiring less invasive post op interventions and overall 30 day complication incidence.

 

Results: 1,026,088 patients were included. Robotic assisted cholecystectomy vs. laparoscopic cholecystectomy was associated with a higher rate of bile duct injury needing a definitive repair within 1 year (0.7% vs 0.2%). Robotic assisted cholecystectomy vs. laparoscopic cholecystectomy was associated with a higher rate of post op biliary interventions (7.4% vs 6.0%). No significant difference in overall 30 day complication rates comparing the 2 procedures.

 

Conclusion: There are significantly higher rates of bile duct injury associated with robotic assisted cholecystectomy compared to laparoscopic cholecystectomy. Laparoscopic cholecystectomies already offer a minimally invasive and safe approach, therefore the use of robotic assisted cholecystectomy should be reconsidered due to higher significance of injury.

 

Limitations:

1. Dependence on accurate diagnoses and billing codes due to retrospective nature
2. Unable to incorporate procedural factors such as severity and chronicity of gallbladder inflammation
3. Unable to identify intraoperative conversions (intraoperative conversions are associated with significantly higher rates of bile duct injury)

 

Clinical Applicability:

This study can help guide clinical practice by helping to determine which form of surgery should be considered the standard of care for cholecystectomy. As robotic assisted surgeries continue to gain popularity and be adopted across the country, additional research is needed to determine its efficacy in each type of case. Clinically, robotic assisted surgeries have been proven to be effective in certain cases that face technical challenges such as prostatectomy, however its use in other cases is not strongly supported by evidence. Additional studies are needed to determine the use of robotic assisted surgeries in different cases in order to provide the best surgery type with the strongest clinical rationale.