TOPLINE:

Robotic-assisted cholecystectomy was associated with more than double the risk for bile duct injury (BDI) requiring operative repair compared with laparoscopic cholecystectomy among Medicare beneficiaries, despite its increasing use between 2020 and 2023.

METHODOLOGY:

• Previous research has found a link between robotic-assisted cholecystectomy and increased rates of BDI, raising safety concerns. However, some analyses suggest that robotic and laparoscopic cholecystectomy may have similar safety profiles, with robotic methods potentially offering advantages.
• Researchers conducted a retrospective cohort study of Medicare beneficiaries who underwent inpatient cholecystectomy from 2020 to 2023 in the US to evaluate trends of use and outcomes of robotic-assisted vs laparoscopic cholecystectomy.
• Patient demographics, comorbidities, and gallbladder disease diagnoses were identified from claims data.
• The primary outcome was BDI requiring operative repair within a year.
• Secondary outcomes were biliary intervention, any postoperative complication, and serious complications.

TAKEAWAY:

• A total of 379,970 Medicare beneficiaries were included, of whom 58,045 underwent robotic-assisted cholecystectomy (mean age, 72.7 years) and 321,925 underwent laparoscopic cholecystectomy (mean age, 73.1 years).
• The use of robotic-assisted cholecystectomy increased substantially from 9.2% of cases in 2020 to 22.4% in 2023.
• Following risk adjustment, robotic-assisted cholecystectomy was linked to a higher risk for BDI than laparoscopic cholecystectomy (0.38% vs 0.18%; relative risk [RR], 2.09; 95% CI, 1.69-2.49). No significant difference was noted in the risk for biliary intervention between the two approaches.
• Robotic procedures were linked to a slightly higher risk for serious complications (RR, 1.09; 95% CI, 1.06-1.13).

IN PRACTICE:

“This finding suggests that although outcomes may be improving as robotic surgery matures, meaningful differences between approaches persist. Although the magnitude of this difference is decreasing, parity with laparoscopic cholecystectomy may only emerge with substantially greater experience with robotic-assisted platforms and likely shifts in operative expertise away from laparoscopy,” the authors of the study wrote.

SOURCE:

The study was led by Cody Lendon Mullens, MD, MPH, MS, Department of Surgery, University of Michigan, Ann Arbor, Michigan. It was published online as a research letter in JAMA Surgery.

LIMITATIONS:

Data were limited to the inpatient setting. Administrative claims data did not have detailed operative and clinical information.

DISCLOSURES:

Two authors received support from the National Institute of Diabetes and Digestive and Kidney Diseases, and one of them reported holding equity in ArborMetrix outside the submitted work. Another author disclosed receiving personal fees from the JAMA Network during the conduct of the study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.