David S Strosberg, MD1, Michelle C Nguyen, MD1, Peter Muscarella II, MD2, Vimal K Narula, MD1. 1The Ohio State University Wexner Medical Center, 2Montefiore Medical Center
Introduction – Robotic-assisted surgery is gaining popularity in general surgery. The cost-effectiveness of robotic surgery has been elucidated, however the cost-outcome association has yet to be determined. Our objective was to evaluate and compare operative outcomes and direct costs for robotic cholecystectomy (RC) and laparoscopic cholecystectomy (LC).
Methods and Procedures – A retrospective review was performed for all patients who underwent single-procedure RC and LC from January 2011 to July 2015 at a large single institution medical center. Demographics, comorbidities, diagnosis, use of cholangiography, conversion to an open procedure, bile duct injury, blood loss, length of surgery and hospital stay, 60-day readmissions, post-operative complications, need for reoperation, and operative and hospital costs were collected and analyzed between those patients groups. Statistical significance was determined using Student’s t-test or Fisher’s exact test.
Results – 272 patients underwent RC or LC during the study period; 256 patients underwent single procedure and comprised the study population. 114 patients (44.5%) underwent LC and 142 patients (55.5%) underwent RC. Patients who underwent RC had a higher body mass index (p=0.0016), lower rates of coronary artery disease (p=0.0038), higher rates of preoperative symptomatic cholelithiasis (p=0.0054) and chronic cholecystitis (0.0115), and lower rates of acute cholecystitis (p<0.0001). There were lower rates of intraoperative cholangiography (p=0.0008), conversion to an open procedure (p=0.0238), blood loss (p=0.012), hospital stay (p=0.0001), and readmission (p=0.033) for robotic cholecystectomy. Patients who underwent RC had longer operative times (p=0.0072). There were no bile duct injuries in either group, no difference in bile leak rates (p=0.6311) or need for reoperation (p=1.000). There was no difference in total direct operative and hospital costs (p=0.365).
Conclusions – Robotic cholecystectomy appears to be safe and cost neutral in comparison to laparoscopic cholecystectomy in a select patient population. Further studies are needed to understand the long-term implications of robotic technology and its role in minimally invasive surgery.