A retrospective comparison of robotic cholecystectomy versus laparoscopic cholecystectomy: operative outcomes and cost analysis

Abstract

Robotic-assisted surgery is gaining popularity in general surgery. Our objective was to evaluate and compare operative outcomes and total costs for robotic cholecystectomy (RC) and laparoscopic cholecystectomy (LC). A retrospective review was performed for all patients who underwent single-procedure RC and LC from January 2011 to July 2015 by a single surgeon at a large academic medical center. Demographics, diagnosis, perioperative variables, postoperative complications, 30-day readmissions, and operative and hospital costs were collected and analyzed between those patient groups. A total of 237 patients underwent RC or LC, and comprised the study population. Ninety-seven patients (40.9%) underwent LC, and 140 patients (50.1%) underwent RC. Patients who underwent RC had a higher body mass index (p=0.03), lower rates of coronary artery disease (p<0.01), and higher rates of chronic cholecystitis (p<0.01). There were lower rates of intraoperative cholangiography (p<0.01) and conversion to an open procedure (p<0.01), however longer operative times (p<0.01) for patients in the RC group. There were no bile duct injuries in either group, no difference in bile leak rates (p=0.65), or need for reoperation (p=1.000). Cost analysis of outpatient-only procedures, excluding cases with conversion to open or use of intraoperative cholangiography, demonstrated higher total charges (p<0.01) and cost (p<0.01) and lower revenue (p<0.01) for RC compared to LC, with no difference in total payments (p=0.34). Robotic cholecystectomy appears to be safe although costlier in comparison with laparoscopic cholecystectomy. Further studies are needed to understand the long-term implications of robotic technology, the cost to the health care system, and its role in minimally invasive surgery.