What are the advantages of robotic-assisted (robotic) cholecystectomy versus laparoscopic cholecystectomy?

From the Guidelines

Laparoscopic cholecystectomy is the preferred method for gallbladder removal due to its established safety profile, cost-effectiveness, and comparable clinical outcomes, with no significant advantages of robotic cholecystectomy over laparoscopic approaches in terms of morbidity, mortality, and quality of life. The provided evidence [ 1 ] supports the use of laparoscopic cholecystectomy as the standard technique for the removal of gallstones, with studies showing a lower complication rate and shorter hospital stay compared to open surgery. Some key points to consider include:

• Laparoscopic cholecystectomy has been shown to be safe and effective in the treatment of acute calculus cholecystitis (ACC), with a lower complication rate and shorter hospital stay compared to open surgery [ 1 ].
• The robotic approach may offer technical advantages, such as enhanced visualization and precision, but these benefits do not consistently translate to superior patient outcomes in routine cases [ 1 ].
• The higher costs and longer operating room setup times associated with robotic cholecystectomy are significant drawbacks that must be considered in the context of limited resources and prioritization of patient outcomes.
• Current evidence does not support the use of robotic cholecystectomy as a replacement for standard laparoscopic approaches in uncomplicated gallbladder removals, and laparoscopic cholecystectomy remains the gold standard due to its established safety profile, cost-effectiveness, and comparable clinical outcomes.

From the Research

Advantages of Robotic vs Laparoscopic Cholecystectomy

• The study by 2 found that robotic cholecystectomy (RC) and laparoscopic cholecystectomy (LC) are comparable in terms of feasibility, safety, and reproducibility of outcomes in all cholecystectomy settings.
• Robotic assistance may be useful in managing biliary injuries during the LC procedure, as noted in the study by 2.
• The study by 3 found that robotic cholecystectomy is associated with lesser duration of stay and lesser readmission rate within 90 days of the index operation, but also greater operative duration and hospital cost compared with laparoscopic cholecystectomy.
• The systematic review and meta-analysis by 4 found that robotic-assisted cholecystectomy (RAC) significantly increased operative time compared with LC, but there were no significant differences between the groups in hospitalization time, occurrence of intraoperative complications, and bile duct injury.
• The observational study by 5 found that both robotic and laparoscopic cholecystectomy are viable approaches in difficult gallbladder cases, with robotic cholecystectomy being associated with potentially fewer complications and conversions to open surgery.

Comparison of Outcomes

• Operative time:
  • The study by 4 found that RAC significantly increased operative time compared with LC (MD 12.59 min; 95% CI 5.62-19.55; p < 0.01).
  • The study by 5 found that the median operative time was significantly higher in the laparoscopic group (108.5 min vs 50.0 min, p = 0.001).
• Hospitalization time:
  • The study by 4 found no significant differences between the groups in hospitalization time (MD -0.18 days; 95% CI - 0.43-0.07; p = 0.07).
• Complications:
  • The study by 4 found no significant differences between the groups in occurrence of intraoperative complications (OR 0.66; 95% CI 0.38-1.15; p = 0.14).
  • The study by 5 found that the total complication rate was higher in the laparoscopic group (14.3% vs 3.8%, OR 4.25,95% CI 0.77-23.28, p = 0.0951), but this difference was not statistically significant.
• Conversion to open surgery:
  • The study by 5 found that the conversion rate was higher in the laparoscopic group (8.6% vs 0.0%, OR 11.52,95% CI 0.57-230.32, p = 0.109), but this difference was not statistically significant.