Robot-Assisted Gallbladder Surgery Linked to Higher Risk of Complications: Study

Complications from the robotic gallbladder removals could included infections, bowel injuries, embolism and heart attacks, researchers warn.

According to the findings of a new study, patients undergoing robotic gallbladder removal surgery often face longer hospital stays and require additional procedures when compared to laparoscopic surgeries.

The findings were published last month in the journal JAMA Surgery, suggesting that robotic gallbladder surgery increases the risk of post-surgical complications, despite many doctors praising the popular alternative to laparoscopic surgery for its ease.

Robotic cholecystectomy (gallbladder removal) surgery allows doctors to use computerized machines with robotic arms to remove the gallbladder with a single incision through the belly button. By comparison, laparoscopic gallbladder surgery uses surgical tools, a small thin tube and small camera, and requires three to four incisions to complete the surgery.

The use of surgical robot-assisted devices is considered revolutionary by doctors and other health experts, because it can allow surgeons to make more precise incisions and, supposedly, reduce complication risks. However, there is not much data confirming if the reduction in complications is more than anecdotal, and concerns have emerged that hospitals often push the procedures after purchasing the expensive surgical robots.

To evaluate the robotic gallbladder surgery complications rates, researchers from Johns Hopkins University School of Medicine studied data on more than 844,000 patients who underwent robotic-assisted cholecystectomies and laparoscopic cholecystectomies, using data from a commercial claims and encounter database from 2016 to 2021.

The research team, led by Dr. Nathnael Abera Woldehana, found that patients from both surgical groups had nearly identical bile duct injury rates. Injury to the bile duct is considered the most serious complication risk from gallbladder removal and can cause fever, abdominal pain, vomiting and jaundice, as well as other long-term health effects. The injuries are often difficult to diagnose and can be missed for months.

However, patients who had robotic gallbladder surgery had an 8% overall post-surgical complication rate, compared to only 5% among the laparoscopic surgery group. Those complications included surgical infections, abdominal abscesses, hemorrhaging, bowel injuries and cardiopulmonary complications like embolism or heart attacks.

Patients in the robotic gallbladder surgery group also had hospital stays of three to four days, in comparison to laparoscopic surgery patients who were discharged after two days, on average.

Additionally, patients in the robotic surgery group were more likely to need surgical drains placed after the surgery, 0.63% compared to 0.48%. The drains are used to help remove the buildup of excess fluids, such as blood and pus.

“These findings suggest that, under current practice conditions, robotic-assisted cholecystectomy may not offer clear benefits compared with the standard, established laparoscopic cholecystectomy approach,” the researchers concluded, indicating that further research is needed to “optimize the use of robotic-assisted cholecystectomy for acute gallbladder disease.”

Robot-Assisted Surgery Concerns

The findings highlight one of several recent concerns about the safety and effectiveness of robot-assisted surgeries, which Woldehana’s team noted has not been well-documented. However, their findings echo the results of similar research published in recent years.

One such study was published in 2023 by researchers from the University of Michigan and the University of California, indicating patients who underwent robot-assisted gallbladder surgery faced a 10% higher risk of suffering surgical complications compared to laparoscopic surgery patients. In that study, the findings suggested patients who had robotic surgeries had higher rates of bile duct injuries.

Other studies have found that patients who undergo robotic surgeries also often need repeat surgeries. One 2021 study concluded robotic-assisted surgeries offer few benefits to patients compared to more traditional surgery methods, including laparoscopic surgeries. The findings noted that it takes a significant amount of time to train surgeons to perform robotic surgeries, their use often leads to longer surgery times and provides no significant improvement in avoiding adverse side effects.