A new study suggests a laparoscopic approach remains predictably safe and that robotic-assisted cholecystectomy is tied to a higher rate of bile duct injury in older adults.
The adoption of robotic-assisted surgery has surged in recent years, with many believing it offers distinct advantages over traditional laparoscopic procedures.
However, whether robotic-assisted cholecystectomy is safer than its laparoscopic counterpart has remained debated.
Now, a new and comprehensive study published in JAMA Surgery sheds light on the matter by assessing the two surgical techniques for cholecystectomy.
And the findings raise questions about the safety of robotic-assisted cholecystectomy compared to the traditional laparoscopic approach.
The primary objective of the retrospective cohort research was to determine the prevalence of robotic-assisted cholecystectomy and evaluate its safety when compared to laparoscopic cholecystectomy.
The US study analysed data from January 2010 to December 2019 and employed Medicare administrative claims data for non-federal acute care hospitals.
It included 1,026,088 fee-for-service Medicare beneficiaries aged 66 to 99 years with continuous Medicare coverage for three months before and 12 months after their cholecystectomy. Data analysis was conducted between August 2022 and June 2023.
The primary outcome measure was the rate of bile duct injury requiring surgical repair within one year following cholecystectomy.
Secondary outcomes included a composite result of bile duct injury requiring less-invasive postoperative surgical or endoscopic biliary interventions and the overall incidence of 30-day complications.
The study encompassed 1,026,088 patients, with a mean age of 72 years and 53.3% women. The use of robotic-assisted cholecystectomy increased significantly over the study period, rising from 0.1% of cases in 2010 to 5.2% in 2019.
In comparison, laparoscopic cholecystectomy remained the predominant technique, accounting for 75.4% in 2010 and 77.8% in 2019.
However, the research found that robotic-assisted cholecystectomy was associated with a higher rate of bile duct injuries requiring surgical repair within one year (0.7% versus 0.2%).
It was also linked to a higher rate of postoperative biliary interventions, such as endoscopic stenting (7.4% vs. 6.0%).
The two procedures had no significant difference in the overall 30-day complication rates.
The authors conclude that their study ‘suggests that the utility of robotic-assisted cholecystectomy should be reconsidered, given the existence of an already minimally invasive, predictably safe laparoscopic approach’.
Further research and analysis are needed to understand better the factors contributing to the observed differences in safety between these two approaches.
