Eric J Charles, MD, J. Hunter Mehaffey, MD, MSc, William J Kane, MD, Robert B Hawkins, MD, MSc, Carlos A Tache-Leon, MD, Zequan Yang, MD. University Of Virginia
Introduction: As robotic surgery becomes more ubiquitous, determining clinical benefit is necessary in order to justify the cost and time investment required to become proficient. The objective of this study was to determine if the use of the robot to perform cholecystectomy was justified. We hypothesized that robotic cholecystectomy would be associated with improved clinical outcomes, but also increased cost, as compared with standard laparoscopic cholecystectomy.
Methods and Procedures: All patients undergoing robotic or laparoscopic cholecystectomy at a single academic hospital between 2007-2017 were identified using an institutional clinical data repository. Patients were propensity score-matched 1:10 based on relevant comorbidities and demographics. Preoperative and intraoperative characteristics, clinical outcomes, and cost were compared based on operative method of cholecystectomy (robotic vs. laparoscopic). Categorical variables were analyzed by Chi-square test and continuous variables using Mann-Whitney U test.
Results: 3,255 patients underwent robotic (n=106) or laparoscopic (n=3149) cholecystectomy during the study period. Unmatched univariate analyses were performed, with no significant differences in sex, race, age, and body mass index. However, the laparoscopic group had much higher rates of medical comorbidities including type II diabetes mellitus, hypertension, chronic obstructive pulmonary disease, obstructive sleep apnea and gastroesophageal reflux disease. To account for differences in baseline demographics, patients were propensity score-matched (n=106 robotic, n=1060 laparoscopic) and compared. After matching, there were no significant differences in demographics or prevalence of preoperative comorbidities. Patients who underwent robotic cholecystectomy had significantly shorter lengths of stay and lower 90-day readmission rates, however operative duration was longer and hospital cost was higher compared with laparoscopic cholecystectomy (Table 1).
Conclusions: Robotic cholecystectomy is associated with shorter length of stay and lower readmission rate within 90-days of the index operation, but also longer operative duration and higher hospital cost compared with laparoscopic cholecystectomy. Hospitals and surgeons need to consider the monetary and time investment required prior to pursuing robotic cholecystectomy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87484
Program Number: S101
Presentation Session: Robotics 2 Session
Presentation Type: Podium