Marthandam Srikanth, Gunjiganvi Mallikarjun, Jasthi Surendra, Atluri Ramya, Reddy Y Satish, Martandam Venkatesh
Department of Surgery, All India Institute of Medical Sciences, Mangalagiri, Mangalagiri, IND.
Department of Surgery, Manipal Hospitals, Vijayawada, IND.
Cureus. 2024 Sep 3;16(9):e68523. doi: 10.7759/cureus.68523. eCollection 2024 Sep.
Background Cholecystectomy, the surgical removal of the gallbladder, is a common procedure performed to treat conditions like gallstone disease and cholecystitis. Among the various techniques available, laparoscopic cholecystectomy (LC) and robotic cholecystectomy (RC) are minimally invasive methods, while open cholecystectomy (OC) involves a more extensive incision and is reserved for cases where less invasive options are unsuitable. This study focuses on evaluating and comparing the safety and efficacy of LC and RC across different grades of cholecystitis, categorized by the Parkland Grading Scale. The goal is to determine whether RC provides significant benefits over LC, particularly in cases of higher-grade cholecystitis. Methodology This ambispective observational case-control study was conducted from January to June 2024 at Manipal Hospitals, Vijayawada, India. It included patients aged 18 or older with acute cholecystitis who underwent LC or OC. Exclusions were made for chronic cholecystitis, prior surgeries affecting the procedure, incomplete records, or severe complications. Data, including demographics, preoperative symptoms, intraoperative details, and postoperative outcomes, were extracted from electronic medical records. Laparoscopic procedures used standard techniques, while robotic procedures employed the da Vinci surgical system. Outcomes measured included operative time, complications, conversion rates, length of stay, and readmission rates. Results There was no significant difference in pre-operative parameters like age, white blood cell (WBC) count, total bilirubin, alanine transaminase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), or history of previous surgery according to the Parkland Grading Scale. However, differences were noted in the Parkland Grading Scale regarding the thickness of the gallbladder wall, incidence of pericholecystic collection, and history of acute cholecystitis (p < 0.05). The most common complication was bleeding during the operation, which was more frequent in LC and was significant. Other complications, such as bile duct injury and vascular injury, were not observed in either procedure. Conclusion This study highlights that RC provides notable benefits compared to LC, especially for higher grades of cholecystitis, as per the Parkland Grading Scale. Although robotic procedures have longer operative times, they result in fewer intraoperative and postoperative complications, reduced conversion rates, and lower readmission rates. These advantages make RC a promising choice for treating complex cases of cholecystitis.
胆囊切除术，即手术切除胆囊，是一种常见的治疗胆结石疾病和胆囊炎等病症的手术。在现有的各种技术中，腹腔镜胆囊切除术（LC）和机器人辅助胆囊切除术（RC）是微创手术方法，而开腹胆囊切除术（OC）需要更大的切口，适用于不太适合采用侵入性较小方法的病例。本研究聚焦于评估和比较根据帕克兰分级量表分类的不同等级胆囊炎中LC和RC的安全性和有效性。目的是确定RC是否比LC具有显著优势，特别是在高等级胆囊炎病例中。
这项前瞻性观察性病例对照研究于2024年1月至6月在印度维杰亚瓦达的马尼帕尔医院进行。研究纳入了年龄在18岁及以上、患有急性胆囊炎且接受了LC或OC的患者。排除标准包括慢性胆囊炎、影响手术的既往手术史、记录不完整或严重并发症。数据包括人口统计学信息、术前症状、术中细节和术后结果，均从电子病历中提取。腹腔镜手术采用标准技术，而机器人手术使用达芬奇手术系统。测量的结果包括手术时间、并发症、中转率、住院时间和再入院率。
根据帕克兰分级量表，术前参数如年龄、白细胞（WBC）计数、总胆红素、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、碱性磷酸酶（ALP）或既往手术史等方面没有显著差异。然而，在帕克兰分级量表中胆囊壁厚度、胆囊周围积液发生率和急性胆囊炎病史方面存在差异（p < 0.05）。最常见的并发症是术中出血，在LC中更频繁且具有显著性。两种手术均未观察到其他并发症，如胆管损伤和血管损伤。
本研究强调，根据帕克兰分级量表，与LC相比，RC具有显著优势，特别是对于高等级胆囊炎。尽管机器人手术的手术时间较长，但术中及术后并发症更少，中转率降低，再入院率更低。这些优势使RC成为治疗复杂胆囊炎病例的一个有前景的选择。
