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Robot-Assisted Interval Cholecystectomy Is Not Inferior to Laparoscopic Interval Cholecystectomy in Advanced
Ikemsinachi C Nzenwa1, Ritwik Sanyal2, Yasmin Arda1
1Division of Trauma, Department of Surgery, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts.
Background:
Robot-assisted cholecystectomy has been recently associated with increased bile duct injury and biliary interventions. Careful patient selection is key to maximizing the benefits of robot-assisted surgery. We used a national dataset to compare complication rates and healthcare utilization between laparoscopic and robot-assisted interval cholecystectomy (IC) after percutaneous cholecystostomy (PCT).
Methods:
We analyzed the 2016-2019 Nationwide Readmissions Database (NRD) to identify adult patients who underwent percutaneous cholecystostomy during an index admission for cholecystitis and later received either laparoscopic or robot-assisted IC on readmission within the same calendar year. The primary outcome was a composite measure of mortality and morbidity. We performed a 2:1 propensity-matched analysis to adjust for clinically relevant confounders. A subgroup analysis of patients treated at high-volume centers was conducted.
Results:
A total of 3179 patients undergoing IC were identified, with 209 (6.6%) receiving robot-assisted surgery. The median age was 72 y and 41.4% were female. After matching, 376 and 188 patients were in the laparoscopic IC and robot-assisted cohorts, respectively. Adjusted analyses revealed no significant difference in the composite mortality-morbidity rate between robot-assisted and laparoscopic IC (37.8% versus 34.3%, P = 0.42). Additionally, there were no significant differences in length of stay and nonroutine discharge rates between the two groups. However, robot-assisted IC was associated with significantly higher hospital costs ($17,077 versus $13,531, P < 0.001). In the subgroup analysis, there were still no significant differences in adverse outcomes between the two surgical approaches, though the cost of hospitalization remained higher for the robot-assisted group ($16,470 versus $14,463, P < 0.001).
Conclusions:
Even after accounting for center volume, robot-assisted and laparoscopic IC yielded comparable outcomes in patients with difficult gallbladders or advanced cholecystitis. While robot-assisted IC does not increase the risk of adverse outcomes, it is associated with higher healthcare costs.
