Lillian M Jones, V Christian Sanderfer, Bryce C Lambert, Cynthia Lauer, Bradley Thomas, Tamara Mrad, Julia Brake, Hongmei Yang, Kaushik Mukherjee, Marilia Montenegro, Michael S Farrell, Pranali Kamat, Patrick Murphy, Danielle Wilson, Corey Ambrose, Matthew J Martin, Lindsay Howe, James Spriggs, Stephanie Eosten Joyce, Jonathan Blancaflor, Shreyus Kulkarni, Scott Rehrig, Michal Radomski, Tanisha Kashikar, Nicholas Truong, Jeffry Nahmias, SaeRam Oh, Caitlin Fitzgerald, Evert Eriksson, Steadman Wang, Robert Despain, Leor Alkadaa, Uzer Khan, Carlos Rodriguez, Graciela Fuentes, Luis Taveras, Mohamed Arafeh, Matthew Painter, Dale Butler, Hillary Prince, Justin Vaughan, Mark Gao, Robin Carlson, Christina Colosimo, A Britton Christmas, Robert Lim, Brent D Matthews, Joseph Sakran, Bruce Crookes, Samuel Wade Ross
Robotic cholecystectomy increased significantly in the ACS population over the study period, with increased use for urgent/emergent biliary surgery. There was no difference between RC and LC in rate of conversion to open when adjusted for confounders. These results demonstrate increased adoption of RC in ACS without increased complication risk, despite a higher-risk population.
BACKGROUND: The use of robotic surgery is increasing in acute care surgery (ACS), especially in patients presenting with acute biliary pathology. This study aimed to evaluate utilization of robotic cholecystectomy (RC) in ACS and compare clinical outcomes to laparoscopic cholecystectomy (LC). We hypothesized that there would be increased utilization of RC over the study period with decreased rates of conversion to open compared to LC, while suspecting RC would have longer operative times.
METHODS: We conducted a retrospective multicenter (15 institutions) study of adult patients undergoing robotic or laparoscopic procedures performed by ACS from 2018 - 2023. Annual case volumes were reviewed for modality (RC vs. LC), operative characteristics, length of stay (LOS), and readmission rates. Multivariate logistic and propensity score matching analyses were performed, controlling for multiple confounders.
RESULTS: A total of 1342 cases were identified (RC = 335, LC = 1007). RC volume increased over time (20 in 2018 to 158 in 2023), while the proportion of urgent/emergent RC cases performed also increased (emergent or urgent: 20% to 55.7%, p = 0.002); On adjusted analyses compared to LC, RC patients had a significantly longer operative duration, though only by 20 min (106 vs. 86 min, p < 0.001). However, the RC group had similar LOS (1.72 vs. 1.78, p = 0.572), and no significant difference in odds of converting to open (0.697, p = 0.565), 30-day ER visit (1.105, p = 0.683), and 10-day readmission (1.189, p = 0.661) compared to LC.
CONCLUSION: Robotic cholecystectomy increased significantly in the ACS population over the study period, with increased use for urgent/emergent biliary surgery. There was no difference between RC and LC in rate of conversion to open when adjusted for confounders. These results demonstrate increased adoption of RC in ACS without increased complication risk, despite a higher-risk population.