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Patient Complexity and Bile Duct Injury After Robotic-Assisted vs Laparoscopic Cholecystectomy.
Cody Lendon Mullens1,2,3, Sarah Sheskey2, Jyothi R Thumma2
1Department of Surgery, University of Michigan, Ann Arbor.
JAMA Network Open
|March 25, 2025
Summary
Robotic-assisted cholecystectomy shows higher bile duct injury rates than laparoscopic surgery, even in lower-risk patients. This study indicates patient selection may not explain the increased risk associated with robotic procedures.
Area of Science:
- Surgical Oncology
- Minimally Invasive Surgery
- Patient Safety
Background:
- Robotic-assisted cholecystectomy (RAC) may have higher bile duct injury (BDI) rates than laparoscopic cholecystectomy (LC).
- Proponents suggest RAC is used for higher-risk patients, potentially explaining BDI differences.
Purpose of the Study:
- To compare the safety of RAC versus LC across different patient risk levels.
- To investigate if patient selection influences BDI rates in RAC.
Main Methods:
- Retrospective cohort study of Medicare beneficiaries (66-99 years) from 2010-2021.
- Risk stratification using random forest and LASSO modeling.
- Analysis of BDI and composite adverse outcomes (complications, reoperations, readmissions).
Main Results:
- Higher BDI rates observed with RAC compared to LC across all risk groups (low, medium, high).
- Overall composite outcomes were similar between RAC and LC.
- Reoperation rates were higher for RAC compared to LC.
Conclusions:
- RAC is associated with increased BDI rates regardless of patient risk level.
- Findings challenge the hypothesis that patient selection explains higher BDI rates in RAC.
- Further investigation into surgical technique and patient factors is warranted.
