title: 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.
authors: Division of General and Gastrointestinal Surgery, Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, 395 W 12th Ave, Suite 654, Columbus, OH, 43210, USA. david.strosberg@osumc.edu.
authors: David S
authors: DS
authors: Strosberg
authors: Division of General and Gastrointestinal Surgery, Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, 395 W 12th Ave, Suite 654, Columbus, OH, 43210, USA.
authors: Michelle C
authors: MC
authors: Nguyen
authors: Montefiore M-E Center for Cancer Care, Bronx, NY, USA.
authors: Peter
authors: P
authors: Muscarella
authors: Division of General and Gastrointestinal Surgery, Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, 395 W 12th Ave, Suite 654, Columbus, OH, 43210, USA.
authors: Vimal K
authors: VK
authors: Narula
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000601:surgery*; D002758:Cholangiography / Q000706:statistics & numerical data; D002761:Cholangitis / Q000601:surgery; D017081:Cholecystectomy, Laparoscopic / Q000191:economics / Q000379:methods*; D002764:Cholecystitis / Q000601:surgery; D042883:Choledocholithiasis / Q000601:surgery; D002769:Cholelithiasis / Q000601:surgery; D002908:Chronic Disease; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D003365:Costs and Cost Analysis; D005260:Female; D005705:Gallbladder Diseases / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cholecystectomy; Cost analysis; Laparoscopic surgery; Robotic surgery