A Retrospective Cohort Study of robotic-assisted surgery in elderly surgical patients with cholelithiasis

Cormac O'Brien; S. Murphy; A. Murphy

doi:10.5281/zenodo.22813457

Authors

Cormac O'Brien Department of General Surgery, Euphrates Institute of Surgical Research Author https://orcid.org/1129-7392-1047-5579
S. Murphy Department of General Surgery, Mekong Institute for Advanced Surgical Research Author https://orcid.org/0451-9275-3439-0505
A. Murphy Division of General Surgery, Yamuna Research Center for Surgical Research Author https://orcid.org/2904-0887-4316-1119

DOI:

https://doi.org/10.5281/zenodo.22813457

Keywords:

Robotic-assisted surgery, Laparoscopic cholecystectomy, Cholelithiasis, Elderly, Retrospective cohort study

Abstract

Graphical abstract

Background: Robotic-assisted cholecystectomy has expanded rapidly, but comparative outcome data specific to elderly patients with cholelithiasis remain limited. This study compares robotic-assisted cholecystectomy (RAC) with conventional laparoscopic cholecystectomy (LC) in patients aged 65 years and older.

Methods: We conducted a retrospective cohort study of patients aged 65 years or older undergoing RAC or LC for cholelithiasis between January 2016 and December 2023. Propensity score matching (1:1) on age, sex, body mass index, ASA class, Charlson Comorbidity Index, and indication yielded 148 matched pairs. Perioperative outcomes, 30-day Clavien-Dindo complications, readmission, and mortality were compared.

Results: Operative time was longer with RAC (94.6 vs 68.2 minutes, p<0.001), while conversion to open surgery was lower (3.7% vs 9.5%, p=0.038), length of stay was shorter (median 1 vs 2 days, p=0.006), and 30-day complications were fewer (12.8% vs 21.6%, p=0.041). Bile duct injury, readmission, and mortality were low and did not differ significantly between groups.

Conclusion: In elderly patients with cholelithiasis, robotic-assisted cholecystectomy was associated with a lower conversion rate, shorter length of stay, and fewer complications than laparoscopic cholecystectomy, despite a longer operative time, supporting its use as a safe alternative in carefully selected older patients.

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