Comparative analysis of laparoscopic and robotic appendectomy: a multi-hospital retrospective cohort study

Appendectomies are one of the most commonly performed procedures by general surgeons in the United States and the laparoscopic approach has been the standard for decades. However, adoption of robotic assistance for the treatment of appendiceal diseases continues to grow. Despite this growth, clinical outcomes regarding laparoscopic versus robotic appendectomy remain unclear.

We conducted a multi-hospital retrospective cohort study of patients who underwent appendectomy between August 1, 2021 and February 29, 2024. We compared preoperative clinical characteristics, intra-operative surgical details, and post-operative outcomes between laparoscopic and robotic groups. The post-operative outcomes analyzed included conversion to open, need for extended resection, 30-day return to the operating room, need for blood transfusion, 30-day readmission, abscess requiring drain, and death. Statistical analysis included chi-square tests, student t-tests, and multivariable logistic regression.

A total of 1,431 patients (1,079 laparoscopic, 352 robotic) were included for analysis. The robotic group was found to have a higher proportion of Caucasian patients, more American Society of Anesthesiologist (ASA) class 1 patients, and a higher proportion of non-elective cases. We found that more robotic appendectomies were completed at community hospital sites rather than larger academic medical centers. Robotic assistance was associated with significantly lower rates of conversion to open (p < 0.001). Additionally, robotics was associated with significantly lower rates of unexpected extended resections (p = 0.015). We saw trends towards statistical significance for reduced need for blood transfusion and abscess requiring IR drain in the robotic group. To account for preoperative differences between the two groups, a multivariable logistic regression analysis was performed, and the robotic group was associated with a 66% decreased risk of any complication (OR = 0.34, 95% CI [0.17, 0.68]).

Robotic appendectomy demonstrates favorable clinical outcomes compared to the traditional laparoscopic approach. These findings support the possible advantages of a robotic-assisted appendectomy.