Does robotic approach in cholecystectomy increase the chance of common bile duct injury in surgeon’s early experience during transition to practice?

Omar Y Kudsi, MD, MBA, FACS, Partha Bhurtel, MD, Katie Sean, MD, Rachel Goldstein, MD, Nivedh Paluvoi, MD. Tufts University School of Medicine

Background:

Surgeon’s experience is associated with a decreased rate of iatrogenic common bile duct injury during cholecystectomy. Practicing general surgeons adopt robotic surgery using training opportunities such as weekend courses, videos, hands-on conferences, and traveling proctors with varying success. This study is aimed to study robotic cholecystectomy outcomes in surgeon’s early experience.

Methods:

This is a retrospective review of prospectively collected data between December 2012 and September 2014. Total of 345 consecutive robotic cases were reviewed of which 279 consecutive robotic cholecystectomies were performed during surgeon’s transition to practice. The study was designed to evaluate the results of robotic cholecystectomy by evaluating the operative time, console time, blood loss, intraoperative and postoperative complications, conversions to open cholecystectomy, and mortality.

Results

We reviewed 345 consecutive patients. (N=279) patients were identified as robotic cholecystectomies including (N= 127) were emergency cases and (N= 152) were elective cases. Demographics were the following: (N= 190) women and (N= 89) men. Mean age was 52.91 years (20-89 years) with a mean BMI of 31.21 (18-71). Out of the 279 cases, (N=7) were converted to open cholecystectomies (2.5%). Mean operative time was 72.79 Minutes (20-259 minutes); including mean console operative time was 43.76 (8-229 minutes) with mean EBL of 21.26 mL (2 -500 mL). Mean length of stay was 0.62 days (0-17 days). Post-operative morbidities: CBD injury (N-1, 0.35%), readmission for Ileus (N=2, 0.7%), post-operative ERCP for retained common bile duct stone (N=1, 0.35%), injury of intra-abdominal organ (N=1, 0.35%), and aspiration of hematoma (N=1, 0.35%). There was no cystic duct leak, wound infection or incisional hernia recorded. There was no mortality.

Conclusion

Robotic cholecystectomy is safe in surgeon’s early experience with comparable outcomes to laparoscopic cholecystectomy. Further studies are planned to address the incidence of complications with growing robotic experience.

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