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Adoption of robotic interval cholecystectomy: a retrospective comparison with the laparoscopic approach at a single
Khalid Mahmoud1, Ivia M Bou Delgado1, Robert A Vierkant2
1Division of Trauma, Critical Care and General Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
Background:
Robotic-assisted cholecystectomy has gained popularity due to its purported advantages over the traditional laparoscopic technique. However, studies to date have not consistently demonstrated improved patient outcomes. Concerns regarding increased costs, particularly when the platform's clinical benefit is unclear, have limited its adoption. To our knowledge, there has been no study focusing on the role of robotic technique in interval cholecystectomy, which may present greater technical challenges, and the advantages offered by robotic technology may lead to improved outcomes.
Methods:
In this retrospective study, we identified patients undergoing cholecystectomy at least one month after either percutaneous or endoscopic drainage of the gallbladder for acute cholecystitis at a single tertiary center between August 2018 and February 2025. Medical records were reviewed to collect patient outcomes for comparison between procedures initiated as robotic-assisted versus laparoscopic-assisted.
Results:
A total of 215 patients, with a mean age of 67 years (± 16), underwent interval cholecystectomy after a median of 102 days (interquartile range (IQR): 85-148 days). Initial therapy for acute cholecystitis was either percutaneous drainage (n = 135, 63%) or endoscopic transcystic duct drainage (n = 80, 37%) of the gallbladder. Interval cholecystectomy was initiated laparoscopically in 177 cases, while 38 surgeries were robotically assisted. Conversion to open cholecystectomy occurred significantly more frequently in the laparoscopic group (33 cases, 19%) compared to the robotic group (0 cases, p < 0.01). Estimated blood loss was also higher in the laparoscopic group (67 ± 74 ml vs 30 ± 25 ml, p < 0.01). Robotic surgeries lasted longer (185 ± 71 vs 155 ± 65 min, p = 0.02).
Conclusions:
In our retrospective review, robotic-assisted interval cholecystectomy is associated with a lower risk of conversion to open surgery, reduced estimated blood loss, and longer operative times when compared to the laparoscopic approach.
