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Background <p>Robotic cholecystectomy represents an increasing proportion of all cholecystectomies. Subtotal fenestrating cholecystectomy (SFC) is a well-described bailout procedure for the difficult cholecystectomy. No prior work has compared traditional laparoscopic SFC to robotic SFC.</p> Study design <p>We performed a single-center retrospective cohort study of adults who underwent robotic or laparoscopic SFC between 2018 and 2024 at a tertiary academic medical center. The primary outcome was composite post-operative biliary events requiring intervention by ERCP. Cost analysis was performed by examining operative cost and total care cost for additional readmission or intervention within 90-day post-operative period. Secondary outcomes were compared using Fisher’s Exact Testing, Mann–Whitney, or independent t-testing as appropriate.</p> Results <p>We reviewed 1851 patients undergoing cholecystectomy, 126 required SFC (6.8%), 96 laparoscopic SFC and 30 robotic SFC. There was no difference in demographics or comorbidity between groups. Unplanned post-operative ERCP was required in 30 patients with a significantly higher rate in laparoscopic SFC (29.2% v 6.7%, <i>p</i> = 0.01). Robotic SFC was noted to have lower overall complication rates (16.6% v 42.7%, <i>p</i> 0.02), estimated blood loss (33.7.cc v. 62.5cc, <i>p</i> = 0.01) and a decrease in the number of days patients required a surgical drain (2.4 v 9.6, <i>p</i> = 0.02). Additionally, robotic SFC had a significantly lower rate of conversion to open (3.3% v 17.7%, <i>p</i> = 0.05). While laparoscopic SFC had lower operative cost ($8119 v $9367, p 0.03), the there was no difference in total cost of care between robotic and laparoscopic groups ($18,695 v $17,270, <i>p</i> 0.71).</p> Conclusion <p>Robotic SFC offers several benefits compared to pure laparoscopic SFC, including decreased biliary leak with lower rates of unplanned ERCP, lower need for conversion to open, and lower overall complication rates. While laparoscopic SFC has lower operative cost, the increased complication and readmission rate results in no difference in overall cost of care.</p>

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Robotic versus pure laparoscopic approach to subtotal fenestrating cholecystectomy: does the robot improve postoperative outcomes?

  • 期刊论文

  • 发表日期：

    2025年11月14日

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  • Katharine E. Caldwell,
  • Edie Threlkeld,
  • Joseph Litrel,
  • Ryan C. Fields,
  • Roheena Z. Panni,
  • Trang Nguyen,
  • Natasha Leigh,
  • Dominic E. Sanford

摘要

Background

Robotic cholecystectomy represents an increasing proportion of all cholecystectomies. Subtotal fenestrating cholecystectomy (SFC) is a well-described bailout procedure for the difficult cholecystectomy. No prior work has compared traditional laparoscopic SFC to robotic SFC.

Study design

We performed a single-center retrospective cohort study of adults who underwent robotic or laparoscopic SFC between 2018 and 2024 at a tertiary academic medical center. The primary outcome was composite post-operative biliary events requiring intervention by ERCP. Cost analysis was performed by examining operative cost and total care cost for additional readmission or intervention within 90-day post-operative period. Secondary outcomes were compared using Fisher’s Exact Testing, Mann–Whitney, or independent t-testing as appropriate.

Results

We reviewed 1851 patients undergoing cholecystectomy, 126 required SFC (6.8%), 96 laparoscopic SFC and 30 robotic SFC. There was no difference in demographics or comorbidity between groups. Unplanned post-operative ERCP was required in 30 patients with a significantly higher rate in laparoscopic SFC (29.2% v 6.7%, p = 0.01). Robotic SFC was noted to have lower overall complication rates (16.6% v 42.7%, p 0.02), estimated blood loss (33.7.cc v. 62.5cc, p = 0.01) and a decrease in the number of days patients required a surgical drain (2.4 v 9.6, p = 0.02). Additionally, robotic SFC had a significantly lower rate of conversion to open (3.3% v 17.7%, p = 0.05). While laparoscopic SFC had lower operative cost ($8119 v $9367, p 0.03), the there was no difference in total cost of care between robotic and laparoscopic groups ($18,695 v $17,270, p 0.71).

Conclusion

Robotic SFC offers several benefits compared to pure laparoscopic SFC, including decreased biliary leak with lower rates of unplanned ERCP, lower need for conversion to open, and lower overall complication rates. While laparoscopic SFC has lower operative cost, the increased complication and readmission rate results in no difference in overall cost of care.