Outcomes Of Robotic-assisted Multiport Cholecystectomy versus Laparoscopic Cholecystectomy - Experience of a High-Volume Robotic Center
Sue Ting Lim, Nicholas Druar, Tian Sheng Ng, Konstantinos Grillas, Vikram S. Bhatt, Shayan Ahmed, John Alexander Palesty
General Surgery, Saint Mary's Hospital, Waterbury, Connecticut, United States
Objective: To investigate the conversion rate to open surgery, length of stay (LOS), complication, and OR time between robotic-assisted multiport (RAS) cholecystectomy and laparoscopic cholecystectomy.
Design: A retrospective chart review study
Setting: Single institution study involving a community teaching hospital which is a high-volume robotic center
Patients. One thousand one hundred thirty-five patients underwent minimally invasive cholecystectomy from July 2018 to June 2021 for any indication.
Interventions. Three hundred sixty-eight patients underwent RAS cholecystectomy with the Da Vinci Robotic Surgical System, and 767 patients underwent laparoscopic cholecystectomy. There is no significant difference in the mean age of patients between the robotic and laparoscopic groups. (51.2 vs. 50.2 years). The BMI body mass index (BMI) of patients in each group was comparable (31.4 vs. 32). There was a similar distribution of urgent cholecystectomies (42.7% vs. 43.7%) and elective cholecystectomies (56.3% vs. 54.9%) between the robotic and laparoscopic groups.
Main Outcome Measures. The primary outcome is the conversion rate to open cholecystectomy. Secondary outcomes are the length of stay (LOS), 30-day complication rate, and procedural time.
Results. In our cohort, there is no statistically significant difference in conversion rate to open cholecystectomies between robotic (1.6%) or laparoscopic (1.7%) cholecystectomies (p=0.58). The length of stay between the two groups was comparable between the robotic and laparoscopic groups (90 vs. 212 hours, p=0.4). There is a significantly lower 30-day complication rate in the robotic group (3%) as compared to the laparoscopic group (5.9%) (p=0.02). Procedural time is significantly shorter in the robotic group when compared to the laparoscopic group (42.6 vs. 67.9 min, p<0.001)
Conclusions. Robotic multiport cholecystectomies performed in a high-volume robotic center may reduce complication rate and procedural time. While robotic cholecystectomies may afford surgeons better optics and movement with endo wrist instrumentation, we failed to demonstrate the advantage of RAS cholecystectomy in reducing the conversion rate to open surgery.
|Outcomes||Robotic Assisted Cholecystectomy||Laparoscopic Cholecystectomy|
|Total Case Number||368||767|
|-Urgent Cases||157 (43.1%)||335 (44.3%)|
|-Elective Cases||207 (56.8%)||421 (55.7%)|
|Conversion to Open Surgery (p=0.42)||6 (1.6%)||13 (1.7%)|
|Mean LOS, hours (p=0.4)||90||212|
|30-day Complication Rate (p=0.02)||11 (3%)||45 (5.9%)|
|Mean procedural time, minutes (p<0.001)||42.6||67.9|
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