Study on cholecystectomy robotic surgery raises safety concerns

Editor's Note

Despite the increasing prevalence of robotic-assisted surgery, recent data on cholecystectomy results indicates minimally invasive laparoscopic methods could be a safer option.

Published in JAMA Surgery on September 20, the nationally representative study of Medicare beneficiary cholecystectomy patients showed a higher rate of bile duct injury (0.7%) for robotic-assisted surgery than laparoscopic procedures (0.2%) from 2010 to 2019, even as the prevalence of the former procedure increased 37-fold.

The data challenge assumptions about inherent technical and safety advantages often used to justify the choice of robotic-assisted surgery. For example, employing robots for lower-risk cholecystectomy procedures to learn the technique may not be justified in cases that are also suitable for a more familiar, predictably safe laparoscopic approach. 

“Our work fills 2 key gaps in knowledge around the comparative outcomes of robotic-assisted surgery,” the researchers wrote. “First, we specifically provided estimates for rates of technical complications, such as bile duct injury, in a nationally representative sample of patients and surgeons. Second, we leveraged variations in how robotic-assisted surgery was adopted to address issues such as selection bias that may lead to incorrect conclusions about why robotic-assisted cholecystectomy may or may not be safer than laparoscopic cholecystectomy.”