A Comparative Study of Laparoscopic Versus Robotic Cholecystectomies Based on the Parkland Grading Scale

Background Cholecystectomy, the surgical removal of the gallbladder, is a common procedure performed to treat conditions like gallstone disease and cholecystitis. Among the various techniques available, laparoscopic cholecystectomy (LC) and robotic cholecystectomy (RC) are minimally invasive methods, while open cholecystectomy (OC) involves a more extensive incision and is reserved for cases where less invasive options are unsuitable. This study focuses on evaluating and comparing the safety and efficacy of LC and RC across different grades of cholecystitis, categorized by the Parkland Grading Scale. The goal is to determine whether RC provides significant benefits over LC, particularly in cases of higher-grade cholecystitis. Methodology This ambispective observational case-control study was conducted from January to June 2024 at Manipal Hospitals, Vijayawada, India. It included patients aged 18 or older with acute cholecystitis who underwent LC or OC. Exclusions were made for chronic cholecystitis, prior surgeries affecting the procedure, incomplete records, or severe complications. Data, including demographics, preoperative symptoms, intraoperative details, and postoperative outcomes, were extracted from electronic medical records. Laparoscopic procedures used standard techniques, while robotic procedures employed the da Vinci surgical system. Outcomes measured included operative time, complications, conversion rates, length of stay, and readmission rates. Results There was no significant difference in pre-operative parameters like age, white blood cell (WBC) count, total bilirubin, alanine transaminase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), or history of previous surgery according to the Parkland Grading Scale. However, differences were noted in the Parkland Grading Scale regarding the thickness of the gallbladder wall, incidence of pericholecystic collection, and history of acute cholecystitis (p < 0.05). The most common complication was bleeding during the operation, which was more frequent in LC and was significant. Other complications, such as bile duct injury and vascular injury, were not observed in either procedure. Conclusion This study highlights that RC provides notable benefits compared to LC, especially for higher grades of cholecystitis, as per the Parkland Grading Scale. Although robotic procedures have longer operative times, they result in fewer intraoperative and postoperative complications, reduced conversion rates, and lower readmission rates. These advantages make RC a promising choice for treating complex cases of cholecystitis.