P M Norwick, BS1, S Shaheen, MD1, J Blebea, MD, MBA1, N Conti2, R Heckburn1, M Zayout3, J Clements, PhD1, M Ghanem, MD1. 1Central Michigan University College of Medicine, 2Case Western University/University Hospitals Medical Center, 3Royal College of Surgeons, Ireland, Dublin
INTRODUCTION: This pilot study was aimed to identify where a patient may or may not benefit from robotic assisted laparoscopic cholecystectomy, versus conventional laparoscopic cholecystectomy to uncover the overall utility of robotic assisted procedures for this common surgical operation.
METHODS AND PROCEDURES: A total of 244 patients were included. Subjects included all patients operated upon by a single surgeon between 2013-June 2018 who met the following inclusion criteria: 1) over age 18, 2) laparoscopic and robotic cholecystectomies performed by single surgeon. We compared clinical outcomes including, OR time, length of stay (LOS), readmission to the hospital, post-op ED visit, and post-op pain between non-robotic assisted single incision (Group A) and robotic assited laparoscopic (Group B) cholecystectomies. A chi square analysis and t-test were used to compare these variables between the two groups. Propensity score matching (PSM) was used to predict the probability of having robotic surgery using gender, age, and BMI as variables.
RESULTS: 144 patients were included in Group A and 100 in Group B. Compared with Group A, Group B was associated with shorter post-operative length of stay (mean, 0.8 vs. 1.61; p= 0.002). There was no significant difference in OR time (mean, 64.82 vs. 65.04; p= 0.945), readmissions (4.0% vs. 3.5%; p= 0.830), post-operative ED visits (7.0% vs. 7.6%; p= 0.851) or post-operative pain (13.0% vs. 21.3%; p= 0.137). Robotic cholecystectomy patients were younger (mean, 46.3 vs. 51.79; p= 0.023) and had lower BMIs (mean, 30.6 vs. 32.7; p= 0.038). There was no significant difference in gender between the two groups. Because of these differences, we conducted PSM which showed no difference between Group A and Group B regarding age, BMI, or gender and the statistical significance of LOS was maintained (mean, 0.93 vs. 1.9; p= 0.009).
CONCLUSION: These data demonstrate that robotic assisted cholecystectomies can reduce LOS for patients undergoing laparoscopic cholecystectomy, without increasing OR time. This enables surgeons to maintain OR fluency by not increasing the time it takes physicians to perform procedures. The reduced LOS would benefit both patient and hospital by decreasing risk of infection, while also reducing hopsital resource usage and cost.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94074
Program Number: P668
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster
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