Woldehana Nathnael Abera, Jung Andrew, Parker Brett Colton, Coker Alisa Mae, Haut Elliott Richard, Adrales Gina Lynn
Division of Minimally Invasive Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
JAMA Surg. 2025 May 21. doi: 10.1001/jamasurg.2025.1291.
The use of robotic-assisted cholecystectomy in acute care surgery is increasing, but its safety and efficacy compared with laparoscopic cholecystectomy remain unclear.
To compare clinical outcomes and bile duct injury rates between robotic-assisted cholecystectomy and laparoscopic cholecystectomy in acute care surgery.
DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective cohort study using patient data from a commercial claims and encounter database from 2016 to 2021. Included in the study were adult patients undergoing robotic-assisted cholecystectomy or laparoscopic cholecystectomy in acute care surgery. Data were analyzed from January to October 2024.
Robotic-assisted or laparoscopic cholecystectomy in acute care surgery.
The primary outcome was bile duct injury.
A total of 844 428 patients (mean [SD] age, 45.6 [12.5] years; 547 665 female [64.9%]) were included in this analysis. After propensity score matching, robotic-assisted cholecystectomy (n = 35 037) and laparoscopic cholecystectomy (n = 35 037) had similar bile duct injury rates (0.37% [128 of 35 037] vs 0.39% [138 of 35 037]; odds ratio [OR], 0.93; 95% CI, 0.73-1.18; P = .54). Robotic-assisted cholecystectomy had higher major postoperative complications (8.37% [2934 of 35 037] vs 5.50% [1926 of 35 037]; OR, 1.57; 95% CI, 1.48-1.67; P < .001), more postoperative drain use (0.63% [219 of 35 037] vs 0.48% [132 of 35 037]; OR, 1.66; 95% CI, 1.34-2.07; P < .001), and longer median (IQR) hospital length of stay (3 [2-4] days vs 2 [1-4] days; P < .001).
In this large, propensity-matched cohort analysis of acute care surgery cholecystectomy, robotic-assisted and laparoscopic cholecystectomy had similar bile duct injury rates, but robotic-assisted cholecystectomy was associated with higher postoperative complications, longer hospital stays, and increased drain use. Further research is needed to optimize the use of robotic-assisted cholecystectomy for acute gallbladder disease. These findings suggest that, under current practice conditions, robotic-assisted cholecystectomy may not offer clear benefits compared with the standard, established laparoscopic cholecystectomy approach.
机器人辅助胆囊切除术在急性护理手术中的应用正在增加，但其与腹腔镜胆囊切除术相比的安全性和有效性仍不明确。
比较机器人辅助胆囊切除术和腹腔镜胆囊切除术在急性护理手术中的临床结局和胆管损伤率。
设计、设置和参与者：这是一项回顾性队列研究，使用了2016年至2021年商业索赔和就诊数据库中的患者数据。纳入研究的是在急性护理手术中接受机器人辅助胆囊切除术或腹腔镜胆囊切除术的成年患者。数据于2024年1月至10月进行分析。
急性护理手术中的机器人辅助或腹腔镜胆囊切除术。
主要结局是胆管损伤。
本分析共纳入844428例患者（平均[标准差]年龄，45.6[12.5]岁；547665例女性[64.9%]）。倾向评分匹配后，机器人辅助胆囊切除术（n = 35037）和腹腔镜胆囊切除术（n = 35037）的胆管损伤率相似（0.37%[35037例中的128例]对0.39%[35037例中的138例]；优势比[OR]，0.93；95%置信区间，0.73 - 1.18；P = 0.54）。机器人辅助胆囊切除术的术后主要并发症发生率更高（8.37%[35037例中的2934例]对5.50%[35037例中的1926例]；OR，1.57；95%置信区间，1.48 - 1.67；P < 0.001），术后引流管使用更多（0.63%[35037例中的219例]对0.48%[35037例中的132例]；OR，1.66；95%置信区间，1.34 - 2.07；P < 0.001），且中位（四分位间距）住院时间更长（3[2 - 4]天对2[1 - 4]天；P < 0.001）。
在这项针对急性护理手术胆囊切除术的大型倾向匹配队列分析中，机器人辅助胆囊切除术和腹腔镜胆囊切除术的胆管损伤率相似，但机器人辅助胆囊切除术与更高的术后并发症、更长的住院时间和更多的引流管使用相关。需要进一步研究以优化机器人辅助胆囊切除术在急性胆囊疾病中的应用。这些发现表明，在当前的实践条件下，与标准的、已确立的腹腔镜胆囊切除术方法相比，机器人辅助胆囊切除术可能没有明显优势。
