Robot-Assisted Interval Cholecystectomy Is Not Inferior to Laparoscopic Interval Cholecystectomy in Advanced...

Area of Science:

• Surgical Innovation
• Minimally Invasive Surgery
• Health Economics

Background:

• Robot-assisted surgery is increasingly used but linked to higher bile duct injury rates.
• Careful patient selection is crucial for robot-assisted procedures.
• This study compares laparoscopic and robot-assisted interval cholecystectomy (IC) after percutaneous cholecystostomy (PCT).

Purpose of the Study:

• To compare complication rates and healthcare utilization between laparoscopic and robot-assisted IC.
• To evaluate outcomes in patients undergoing IC after PCT.
• To assess the impact of center volume on outcomes.

Main Methods:

• Analysis of the 2016-2019 Nationwide Readmissions Database (NRD).
• Inclusion of adult patients who underwent PCT for cholecystitis and subsequent IC (laparoscopic or robot-assisted).
• 2:1 propensity-matched analysis comparing composite mortality-morbidity, length of stay, discharge rates, and costs; subgroup analysis of high-volume centers.

Main Results:

• No significant difference in composite mortality-morbidity rates between robot-assisted and laparoscopic IC (37.8% vs. 34.3%).
• Similar length of stay and nonroutine discharge rates for both approaches.
• Robot-assisted IC was associated with significantly higher hospital costs ($17,077 vs. $13,531).

Conclusions:

• Robot-assisted and laparoscopic IC offer comparable clinical outcomes in patients with complex gallbladders or advanced cholecystitis.
• Robot-assisted IC does not increase the risk of adverse outcomes.
• Robot-assisted IC is associated with higher healthcare costs compared to laparoscopic IC.