Comparison between robotic-assisted cholecystectomy and laparoscopic cholecystectomy using a systematic registry of adverse events. Is the robotic approach safe?

Abstract

Background

Robotic-assisted cholecystectomy (RC) is a minimal invasive surgery technique. It is not available at every hospital, and higher complication rates have been described in larger series.

Methods

A prospective and descriptive study of patients with only elective cholecystectomies since the implementation of robotic surgery at our institution. Patients with urgent procedures were excluded.

Primary endpoint: to compare postoperative complications between laparoscopic cholecystectomies (LC) and RC. Secondary endpoint: to determine the existence of differences between both groups in demographic, surgical and postoperative variables.

Results

Between March 2022 and November 2024, 391 patients underwent cholecystectomy (75.7% LC, 24.3% RC). Three LC were converted to open surgery, and 9 patients were readmitted (7-LC, 2-RC). Only one patient was reoperated.

Median operative time (in minutes) was significantly longer (P = .001) in RC than LC (73 vs 59). Although the console time in RC was shorter (66) the difference was still significant (P = .02).

There were no significant differences in hospital stay or the CCI (Comprehensive Complication Index). However, significant differences in Clavien Dindo were found in favor of RC (P = .042) (LC: 3 IIIa, one IVa, RC: one IIIa, one IVa). There were 4 abscesses (3 LC, one RC) and 2 biliary fistulas in LC (one drained percutaneously, one reoperated). In the RC group, one patient presented myocardial infarction and another residual choledocholithiasis.

Conclusions

RC needs a longer operative time but seems to be as safe as LC in terms of the number of adverse events. It can be considered a safe technique for cholecystectomies.

Resumen

Introducción

La colecistectomía asistida por robot (CAR) es una técnica mínimamente invasiva no disponible en todos los hospitales. Se describen mayores tasas de complicaciones en series amplias.

Métodos

Estudio prospectivo y descriptivo de colecistectomías electivas desde el inicio de la cirugía robótica en nuestra institución. Se excluyeron los procedimientos urgentes.

Objetivo principal: comparar las complicaciones posoperatorias entre las colecistectomías laparoscópicas (CL) y las CAR. Objetivos secundarios: determinar diferencias demográficas, quirúrgicas y posoperatorias entre grupos.

Resultados

Entre marzo de 2022 y noviembre de 2024, 391 pacientes fueron incluidos (75,7% CL, 24,3% CAR). Tres CL se convirtieron a cirugía abierta.

9 fueron readmitidos (7-CL, 2-CAR). Solo un paciente fue reintervenido.

Se necesitó un tiempo quirúrgico superior (p = 0,001) (mediana en minutos) para la CAR respecto la CL (73 frente 59). Aunque el tiempo de consola en la CAR fue menor (66), la diferencia siguió siendo significativa (p = 0,02).

No hubo diferencias significativas en la estancia hospitalaria o el CCI (Comprehensive Complication Index). Sí se encontraron diferencias significativas en Clavien Dindo a favor de la CAR (p = 0,042). CL: 3 IIIa, 1 IVa. CR: 1 IIIa, 1 IVa. Hubo 4 abscesos (3-CL, 1-CAR) y 2 fístulas biliares en la CL (1 drenada percutáneamente, 1 reintervenida). En la robótica, un paciente presentó un infarto de miocardio y otro una coledocolitiasis residual.

Conclusiones

La CAR requiere un tiempo operatorio más prolongado pero parece ser tan segura como la CL respecto a los efectos adversos. Puede considerarse una técnica segura para las colecistectomías.