Robotic vs Laparoscopic Cholecystectomy: Which Is Safer?

INTRODUCTION: Robotic-assisted procedures have gained popularity with increased availability and improved training. We aim to evaluate outcomes, short and medium term, in patients undergoing laparoscopic or robotic cholecystectomy. METHOD(S): Retrospective study of elective laparoscopic and robotic cholecystectomies performed in patients 18 years and older from 2012 to 2017 at a tertiary institute. Inclusion criteria is outpatient standard 4-port procedures. We excluded all incomplete medical charts, nonstandard 4-port operations and patients who underwent cholecystectomies with concurrent procedures. Complication outcomes were assessed at 0 days, 30 days, and 1 year. Data analysis was carried out using SAS, version 9.4 (SAS Institute). RESULT(S): A total of 610 charts were reviewed with 340 subjects included in our study. Significant findings are seen with 10 of 94 (10.6%) laparoscopic compared with 13 of 246 (5.3%) robotic patients returning to the emergency department (p = 0.02), and 8 of 94 (8.5%) compared with 4 of 246 (1.6%) respectively from each group were readmitted (p = 0.0004), both within 30 days after operation. There were no significant differences in demographics, preoperative Charlson Comorbidity Index, and postoperative Clavien-Dindo classification. Conversion rates to open cholecystectomy was 2 of 94 (2.1%) in the laparoscopic arm and 1 of 246 (0.4%) in the robotic arm, but not significant. CONCLUSION(S): Our study demonstrates higher emergency department visits and readmission rates in the short term from laparoscopic cholecystectomy when compared with robotic cholecystectomy. Overall, complication outcomes between laparoscopic and robotic cholecystectomies are not statistically significant in both short- and medium-term. We conclude that performing either technique is safe in an elective setting, but with higher rehospitalizations in the laparoscopic arm.