Robotic vs. Laparoscopic Cholecystectomy: Study finds No Clear Advantage for Robotic Approach
Researchers have found in a large, propensity-matched cohort study of acute care cholecystectomy cases, that both robotic-assisted and laparoscopic techniques showed similar bile duct injury rates. However, robotic-assisted cholecystectomy was linked to higher postoperative complications, longer hospital stays, and increased drain usage. These results indicate that, under current conditions, robotic-assisted cholecystectomy may not provide clear benefits over the standard laparoscopic method, highlighting the need for further research to optimize its use.
The study was published in JAMA Surgery by Nathnael A. and fellow researchers. This retrospective cohort analysis compared information loss from 844,428 adult patients undergoing cholecystectomy in an acute care environment during 2016-2021. Patients were sampled from a U.S. commercial encounter and loss-adjusted claims database. Propensity scoring was employed by researchers to match 35,037 robotic-assisted cholecystectomy with 35,037 laparoscopic cholecystectomy cases, balancing clinical factors for equitable comparison. Data analysis was performed in 2024.
The primary outcome was bile duct injury, a severe complication that may cause considerable morbidity. Secondary outcomes comprised postoperative complications, hospital stay, and postoperative drain use.
Key Findings
The study revealed no significant difference in bile duct injury rates between the two surgical methods:
• Bile duct injury occurred in 0.37% (128 of 35,037) of robotic-assisted cases vs 0.39% (138 of 35,037) of laparoscopic cases
• Odds Ratio (OR): 0.93
• 95% Confidence Interval (CI): 0.73–1.18
• P = 0.54 (not statistically significant)
However, robotic-assisted cholecystectomy was associated with worse outcomes in several other important measures:
• Major postoperative complications were significantly higher:
• 8.37% (2,934 of 35,037) in the robotic group vs 5.50% (1,926 of 35,037) in the laparoscopic group
• OR: 1.57; 95% CI: 1.48–1.67; P < 0.001
Postoperative drain use was also greater with robotic surgery:
• 0.63% (219 of 35,037) vs 0.48% (132 of 35,037)
• OR: 1.66; 95% CI: 1.34–2.07; P < 0.001
• Median hospital stay was longer for robotic patients:
• 3 days (interquartile range [IQR]: 2–4) vs 2 days (IQR: 1–4); P < 0.001
Robotic-assisted and laparoscopic cholecystectomy were shown to have equivalent bile duct injury rates in acute care surgery. Robotic-assisted surgery, however, had greater complication rates, longer lengths of stay, and more drainage use. These results indicate that, in its current state of development and use, robotic-assisted cholecystectomy does not have a clear benefit over conventional laparoscopic techniques.
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