Stefanova Irena, Callahan Rosie, Giriradder Vandana B, Merali Nabeel, Renardson Lydia, Lam Shi, Liau Siong-Seng, Platt Esther, Riga Angela, Kumar Rajesh, Worthington Tim R, Frampton Adam E, Lahiri Rajiv P, Pencavel Tim D, Ahmad Jawad
Royal Liverpool University Hospital NHS Trust, Liverpool, UK.
HPB Surgical Unit, Royal Surrey Hospital NHS Trust, Guildford, UK.
Surg Endosc. 2025 Aug 28. doi: 10.1007/s00464-025-12044-1.
Subtotal and abandoned cholecystectomies are on the rise due to the increase of laparoscopic cholecystectomies performed in the emergency setting. Persistent biliary symptoms postoperatively may necessitate a completion cholecystectomy (CC) which is a technically challenging procedure. The literature describing outcomes of minimally invasive CC is scarce and consisting of small studies only. This retrospective multi-centre study aimed to assess the safety and effectiveness of the robotic approach to CC.
All consecutive patients (> 18 years), undergoing a robotic CC between August 2020 and March 2025, were included. Primary outcome was success of robotic procedure. Secondary outcomes were open conversion, subtotal and abandoned cholecystectomy rate, postoperative complications, length of hospital stay, 30-day re-admission and 90-day mortality. A P value < 0.05 was considered significant. Data were analysed using IBM SPSS Statistics Version 29.0.1.0 (171).
A total of 44 adult patients with a median age was 58.5 years (IQR: 43.5 - 73.3) undergoing robotic CC were included. Previous subtotal cholecystectomy was performed in 72.7% (32/44) of referrals, whereas abandoned cholecystectomy was recorded in 27.3% (12/44). There were no abandoned robotic CCs. Subtotal cholecystectomy was required in two cases (4.5%, 2/44), and conversion to open procedure was reported in one case 2.3% (1/44). A successful robotic CC was documented in 93.2% (41/44) of procedures. Overall morbidity rate was 6.8% (3/44) with a Clavien-Dindo grade ≥ 3 in 2.3% (1/44) of cases. All complications were observed in the previous subtotal cholecystectomy group (9.4%, 3/32) vs the abandoned cholecystectomy group (0%, 0/12), however, this difference was not significant (P = 0.55, 95% CI [-0.065, 0.25]).
Robotic CC is a safe and technically feasible approach with high success and low complication rates. This study, the largest of its kind, supports the expanding role of robotic platforms in managing difficult gallbladder pathology in the re-operative setting.
由于急诊腹腔镜胆囊切除术的增加，胆囊次全切除术和放弃胆囊切除术的比例呈上升趋势。术后持续的胆道症状可能需要进行胆囊切除术（CC），这是一项技术上具有挑战性的手术。描述微创CC手术结果的文献很少，且仅包括小型研究。这项回顾性多中心研究旨在评估机器人辅助CC手术的安全性和有效性。
纳入2020年8月至2025年3月期间连续接受机器人辅助CC手术的所有患者（年龄>18岁）。主要结局是机器人手术的成功。次要结局包括中转开腹、胆囊次全切除术和放弃胆囊切除术的发生率、术后并发症、住院时间、30天再入院率和90天死亡率。P值<0.05被认为具有统计学意义。数据使用IBM SPSS Statistics Version 29.0.1.0（171）进行分析。
共纳入44例接受机器人辅助CC手术的成年患者，中位年龄为58.5岁（四分位间距：43.5 - 73.3岁）。在72.7%（32/44）的转诊病例中曾进行过胆囊次全切除术，而27.3%（12/44）的病例记录为放弃胆囊切除术。没有放弃机器人辅助CC手术的情况。2例（4.5%，2/44）需要进行胆囊次全切除术，1例（2.3%，1/44）报告中转开腹手术。93.2%（41/44）的手术记录为成功的机器人辅助CC手术。总体发病率为6.8%（3/44），Clavien-Dindo分级≥3级的病例占2.3%（1/44）。所有并发症均出现在既往胆囊次全切除术组（9.4%，3/32），而放弃胆囊切除术组为0%（0/12），然而，这种差异无统计学意义（P = 0.55，95%可信区间[-0.065, 0.25]）。
机器人辅助CC手术是一种安全且技术上可行的方法，成功率高且并发症发生率低。这项同类研究中规模最大的研究支持了机器人平台在处理再次手术中困难胆囊病变方面日益扩大的作用。
