Robotic versus laparoscopic common bile duct exploration: outcomes from a high-volume specialist pancreaticobiliary unit within a structured minimally invasive pathway.

BACKGROUND

Laparoscopic common bile duct exploration (LCBDE) is an established single-stage treatment for choledocholithiasis. Robotic CBDE (RCBDE) has been proposed to overcome technical limitations of laparoscopy, particularly in complex cases, but comparative data remain limited. This study evaluates outcomes of LCBDE versus RCBDE within a high-volume specialist pancreaticobiliary unit.

METHODS

A retrospective cohort study of consecutive patients undergoing common bile duct exploration (CBDE) between January 2011 and March 2026 was performed. Patients were stratified into LCBDE and RCBDE groups. The primary outcome was complete bile duct clearance. Secondary outcomes included operative time, conversion, length of stay, morbidity (Clavien-Dindo), bile leak, retained stones, readmission, and reintervention. To address treatment selection bias, inverse probability of treatment weighting (IPTW) was applied.

RESULTS

A total of 547 patients underwent CBDE (498 LCBDE; 49 RCBDE). Duct clearance was achieved in 496 (99%) laparoscopic and 49 (100%) robotic cases (p = 0.432). Retained stones occurred in 13 (3%) and 1 (2%) patients, respectively (p = 1.000). Median operative time was longer for RCBDE (156 vs 140 min, p = 0.015). Major morbidity (Clavien-Dindo ≥ III) was comparable (5% vs 10%, p = 0.108), with no differences in bile leak, readmission, reintervention, or length of stay. There were no deaths. IPTW-adjusted analysis demonstrated no differences in primary or secondary outcomes, aside from longer operative duration with RCBDE. Findings were consistent in a contemporary subgroup (2022-2026).

CONCLUSION

RCBDE is safe and achieves outcomes comparable to laparoscopic exploration within a high-volume specialist unit. Although associated with longer operative duration, robotic platforms may provide technical advantages in selected technically demanding scenarios. Further studies incorporating standardised complexity grading are required to better define the role of RCBDE in advanced biliary disease.