Robotic compared with laparoscopic cholecystectomy: A propensity matched analysis

Published:September 03, 2019DOI:



      As robotic surgery becomes more ubiquitous, determining clinical benefit is necessary to justify the cost and time investment required to become proficient. We hypothesized that robotic cholecystectomy would be associated with improved clinical outcomes but also increased cost as compared with standard laparoscopic cholecystectomy.

      Materials and Methods

      All patients undergoing robotic or laparoscopic cholecystectomy at a single academic hospital between 2007 and 2017 were identified using an institutional clinical data repository. Patients were stratified by operative approach (robotic versus laparoscopic) for comparison and propensity score matched 1:10 based on relevant comorbidities and demographics. Categorical variables were analyzed by the χ2 test and continuous variables using the Mann-Whitney U test.


      A total of 3,255 patients underwent cholecystectomy during the study period. We observed no differences in demographics or body mass index, but greater rates of diabetes mellitus, hypertension, and gastroesophageal reflux disease were present in the laparoscopic group. After matching (n = 106 robotic, n = 1,060 laparoscopic), there were no differences in preoperative comorbidities. Patients who underwent robotic cholecystectomy had lesser durations of stay (robotic: 0.1 ± 0.7 versus laparoscopic: 0.8 ± 1.9, P < .0001) and lesser 90-day readmission rates (robotic: 0% [0], laparoscopic: 4.1% [43], P = 0.035); however, both operative and hospital costs were greater compared with laparoscopic cholecystectomy.


      Robotic cholecystectomy is associated with lesser duration of stay and lesser readmission rate within 90 days of the index operation, but also greater operative duration and hospital cost compared with laparoscopic cholecystectomy. Hospitals and surgeons need to consider the improved clinical outcomes but also the monetary and time investment required before pursuing robotic cholecystectomy.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hall M.J.
        • Schwartzman A.
        • Zhang J.
        • Liu X.
        Ambulatory surgery data from hospitals and ambulatory surgery centers: United States, 2010.
        Natl Health Stat Report. 2017; 102: 1-14
        • Soper N.J.
        • Stockmann P.T.
        • Dunnegan D.L.
        • Ashley S.W.
        Laparoscopic cholecystectomy the new ‘gold standard’?.
        Arch Surg. 1992; 127: 917-921
        • Wilson R.G.
        • Macintyre I.M.
        • Nixon S.J.
        • Saunders J.H.
        • Varma J.S.
        • King P.M.
        Laparoscopic cholecystectomy as a safe and effective treatment for severe acute cholecystitis.
        Br Med J. 1992; 305: 394-396
        • Lin S.
        • Jiang H.G.
        • Chen Z.H.
        • Zhou S.Y.
        • Liu X.S.
        • Yu J.R.
        Meta-analysis of robotic and laparoscopic surgery for treatment of rectal cancer.
        World J Gastroenterol. 2011; 17: 5214-5220
        • Altieri M.S.
        • Yang J.
        • Telem D.A.
        • et al.
        Robotic approaches may offer benefit in colorectal procedures, more controversial in other areas: A review of 168,248 cases.
        Surg Endosc. 2016; 30: 925-933
        • Baek N.H.
        • Li G.
        • Kim J.H.
        • et al.
        Short-term surgical outcomes and experience with 925 patients undergoing robotic cholecystectomy during a 4-year period at a single institution.
        Hepatogastroenterology. 2015; 62: 573-576
        • Ayloo S.
        • Roh Y.
        • Choudhury N.
        Laparoscopic versus robot-assisted cholecystectomy: A retrospective cohort study.
        Int J Surg. 2014; 12: 1077-1081
        • Breitenstein S.
        • Nocito A.
        • Puhan M.
        • Held U.
        • Weber M.
        • Clavien P.A.
        Robotic-assisted versus laparoscopic cholecystectomy: Outcome and cost analyses of a case-matched control study.
        Ann Surg. 2008; 247: 987-993
        • Zhou H.X.
        • Guo Y.H.
        • Yu X.F.
        • et al.
        Zeus robot-assisted laparoscopic cholecystectomy in comparison with conventional laparoscopic cholecystectomy.
        Hepatobiliary Pancreat Dis Int. 2006; 5: 115-118
        • Vidovszky T.J.
        • Smith W.
        • Ghosh J.
        • Ali M.R.
        Robotic cholecystectomy: Learning curve, advantages, and limitations.
        J Surg Res. 2006; 36: 172-178
        • Pietrabissa A.
        • Pugliese L.
        • Vinci A.
        • et al.
        Short-term outcomes of single-site robotic cholecystectomy versus four-port laparoscopic cholecystectomy: A prospective, randomized, double-blind trial.
        Surg Endosc. 2016; 30: 3089-3097
        • Gangemi A.
        • Danilkowicz R.
        • Elli F.E.
        • Bianco F.
        • Masrur M.
        • Giulianotti P.C.
        Could ICG aided robotic cholecystectomy reduce the rate of open conversion reported with laparoscopic approach? A head to head comparison of the largest single institution studies.
        J Robot Surg. 2017; 11: 77-82
        • Strosberg D.S.
        • Nguyen M.C.
        • Muscarella P.
        • Narula V.K.
        A retrospective comparison of robotic cholecystectomy versus laparoscopic cholecystectomy: Operative outcomes and cost analysis.
        Surg Endosc Other Interv Tech. 2017; 31: 1436-1441
        • Rosemurgy A.
        • Ryan C.
        • Klein R.
        • Sukharamwala P.
        • Wood T.
        • Ross S.
        Does the cost of robotic cholecystectomy translate to a financial burden?.
        Surg Endosc. 2015; 29: 2115-2120
        • Casillas M.A.
        • Leichtle S.W.
        • Wahl W.L.
        • et al.
        Improved perioperative and short-term outcomes of robotic versus conventional laparoscopic colorectal operations.
        Am J Surg. 2014; 208: 33-40
        • Yamaguchi T.
        • Kinugasa Y.
        • Shiomi A.
        • Sato S.
        • Yamakawa Y.
        • Kagawa H.
        • Tomioka H.
        • Mori K.
        Learning curve for robotic-assisted surgery for rectal cancer: Use of the cumulative sum method.
        Surg Endosc. 2015; 29: 1679-1685