We read with great interest the study by Kalata et al.published in JAMA Surgery comparing the safety of robotic-assisted cholecystectomy(RAC)vs.laparoscopic cholecystectomy(LC)(1).This nationwide cohort study from the...We read with great interest the study by Kalata et al.published in JAMA Surgery comparing the safety of robotic-assisted cholecystectomy(RAC)vs.laparoscopic cholecystectomy(LC)(1).This nationwide cohort study from the United States includes more than one million patients who had a cholecystectomy from January 1,2010 to December 31,2019.An impressive 37-fold increase in the use of RAC is reported during this period.Uncannily,RAC was found to have a three times higher rate of bile duct injuries requiring surgical repair with choledochojejunostomy or hepaticojejunostomy within one year from surgery when compared to LC.Similarly,RAC in comparison to LC had a higher incidence of postoperative biliary interventions with endoscopic retrograde cholangiopancreatography and common bile duct exploration[7.4%vs.6.0%;relative risk(RR)=1.25;95%confidence interval(CI):1.16-1.33].In addition,an instrumental variable analysis was undertaken to investigate the causality of this result and found that RAC had two times more bile duct injuries requiring surgical reconstruction when compared to LC(0.4%vs.0.2%;RR=1.88;95%CI:1.14-2.63).展开更多
文摘We read with great interest the study by Kalata et al.published in JAMA Surgery comparing the safety of robotic-assisted cholecystectomy(RAC)vs.laparoscopic cholecystectomy(LC)(1).This nationwide cohort study from the United States includes more than one million patients who had a cholecystectomy from January 1,2010 to December 31,2019.An impressive 37-fold increase in the use of RAC is reported during this period.Uncannily,RAC was found to have a three times higher rate of bile duct injuries requiring surgical repair with choledochojejunostomy or hepaticojejunostomy within one year from surgery when compared to LC.Similarly,RAC in comparison to LC had a higher incidence of postoperative biliary interventions with endoscopic retrograde cholangiopancreatography and common bile duct exploration[7.4%vs.6.0%;relative risk(RR)=1.25;95%confidence interval(CI):1.16-1.33].In addition,an instrumental variable analysis was undertaken to investigate the causality of this result and found that RAC had two times more bile duct injuries requiring surgical reconstruction when compared to LC(0.4%vs.0.2%;RR=1.88;95%CI:1.14-2.63).
