Do we really need the robot? Laparoscopic vs. robotic-assisted cholecystectomy

Doing things the old-fashioned way is sometimes better than using fancy robotic technology.This was the finding in a study comparing robotic-assisted cholecystectomy to the good ol’ traditional approach of laparoscopic cholecystectomy.While robotic-assisted surgery “was initially marketed for its ability to overcome technical challenges associated with certain procedures (eg, prostatectomy), it has since expanded into domains with weaker clinical rationale and limited evidence,” researchers wrote in JAMA Network Open. It was unclear whether robotic-assisted cholecystectomy leads to safer outcomes than minimally invasive laparoscopic cholecystectomy which is already known to rank high in the safety department.A study evaluated the comparative safety of robotic-assisted to laparoscopic cholecystectomy among a diverse group of patients and surgeons using data for 1,026,088 U.S. Medicare beneficiaries over a 10-year period. A total of 53.3% were female and 46.7% male. The primary outcome was bile duct injury requiring surgical repair. Regional variations in terms of whether or not robotic-assisted cholecystectomy was used for the comparison.The data encompassed the period from January 1, 2010, to December 31, 2019. Overall, 1,001,004 patients underwent laparoscopic surgery and 25,084 had the robotic assisted procedure.During the decade, the use of robotic-assisted cholecystectomy increased 37-fold from 211 of 147,341 patients in 2010, to 6,507 of 125,211 patients in 2019, the paper said.The use of laparoscopic cholecystectomy rose from 111,149 of 147,341 patients in 2010, to 97,427 of 125,211 patients in 2019. A total of 12,819 of 1,025,520 patients had a bile duct injury and underwent surgical repair. Overall, it was found that robotic-assisted cholecystectomy was associated with higher risk of bile duct injury which needed an operative repair within one year, 0.7% of patients compared to 0.2% of laparoscopic cholecystectomy patients.Compared with laparoscopic cholecystectomy, robotic-assisted cholecystectomy was also associated with higher rates of biliary interventions, 7.4% versus 6.0% respectively, and serious complications—9.3% compared to 8.6%.The researchers concluded “our data suggest that the utility of robotic-assisted cholecystectomy should be reconsidered, given the availability of an already minimally invasive, predictably safe laparoscopic approach.”

Do we really need the robot? Laparoscopic vs. robotic-assisted cholecystectomy

Register for free access or login.

Related Topics