Comparison between robotic-assisted cholecystectomy and laparoscopic cholecystectomy using a systematic registry of adverse events. Is the robotic approach safe?

BACKGROUND

Robotic-assisted cholecystectomy (RC) is a minimal invasive surgery technique. It is not available at every hospital, and higher complication rates have been described in larger series.

METHODS

A prospective and descriptive study of patients with only elective cholecystectomies since the implementation of robotic surgery at our institution. Patients with urgent procedures were excluded.

PRIMARY ENDPOINT: to compare postoperative complications between laparoscopic cholecystectomies (LC) and RC. Secondary endpoint: to determine the existence of differences between both groups in demographic, surgical and postoperative variables.

RESULTS

Between March 2022 and November 2024, 391 patients underwent cholecystectomy (75.7% LC, 24.3% RC). Three LC were converted to open surgery, and 9 patients were readmitted (7-LC, 2-RC). Only one patient was reoperated. Median operative time (in minutes) was significantly longer (P = .001) in RC than LC (73 vs 59). Although the console time in RC was shorter (66) the difference was still significant (P = .02). There were no significant differences in hospital stay or the CCI (Comprehensive Complication Index). However, significant differences in Clavien Dindo were found in favor of RC (P = .042) (LC: 3 IIIa, one IVa, RC: one IIIa, one IVa). There were 4 abscesses (3 LC, one RC) and 2 biliary fistulas in LC (one drained percutaneously, one reoperated). In the RC group, one patient presented myocardial infarction and another residual choledocholithiasis.

CONCLUSIONS

RC needs a longer operative time but seems to be as safe as LC in terms of the number of adverse events. It can be considered a safe technique for cholecystectomies.