Posted: Friday, October 13, 2023
JAMA Surgery has published new research examining the utilization rates and comparative safety of robotic-assisted cholecystectomy in the United States versus the current standard-of-care laparoscopic procedure. In their large, retrospective cohort study, Stanley Kalata, MD, MS, of the University of Michigan, Ann Arbor, and colleagues observed a 37-fold increase in robotic-assisted cholecystectomies over a 10-year period, which they reported were associated with significantly higher rates of bile duct injury compared with the laparoscopic cholecystectomy. As a result, the researchers questioned the continued use of robotic-assisted cholecystectomy.
“Our work fills two key gaps in knowledge around the comparative outcomes of robotic-assisted surgery,” the investigators noted. “First, we specifically provided estimates for rates of technical complications, such as bile duct injury, in a nationally representative sample of patients and surgeons. Second…we provided a specific mechanism by which robotic-assisted cholecystectomy was less safe despite the purported benefits inherent to the technology. In the absence of a clear safety advantage, it is not clear what problem the robotic technology is addressing.”
A total of 1,026,088 Medicare beneficiaries who underwent cholecystectomy between 2010 and 2019 were included in the study. The researchers reported that compared with laparoscopic cholecystectomy, robotic-assisted cholecystectomy was associated with a higher rate of bile duct injury that necessitated a definitive operative repair within 1 year (0.7% vs. 0.2%; relative risk [RR] = 3.16; 95% confidence interval [CI] = 2.57–3.75) and a higher rate of postoperative biliary interventions, such as endoscopic stenting (7.4% vs. 6.0%; RR = 1.25; 95% CI = 1.16–1.33). An instrumental variable analysis—conducted to account for potential unmeasured differences in treatment groups—also indicated robotic-assisted cholecystectomy was associated with a higher rate of bile duct injury (0.4% vs. 0.2%; RR = 1.88; 95% CI = 1.14–2.63).
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.