A single-center experience of over 600 cases of robotic cholecystectomy: a propensity score match analysis

Background: Minimally invasive surgery is the gold standard for cholecystectomy and robotic-assisted cholecystectomy has been shown to be comparable if not better than the laparoscopic technique, in terms of postoperative outcomes. We aim to compare outcomes of different robotic approaches for cholecystectomy in a high-volume Center with a large experience in robotic surgery in using robotic multiport (MP), robotic single-site (SS) and robotic single-port approach (SP). Methods: Data from 611 patients who underwent elective robotic cholecystectomy with MP, SS or SP technique were retrospectively collected between 2012 and 2024. All surgeries were performed by the same surgeon. Urgent cholecystectomies were excluded. A propensity score weighted analysis were used to balance the three groups and short-term outcomes were compared. Results: After the weighting using general characteristics (age, gender, BMI, ASA scale, comorbidity, and previous abdominal surgery), three groups of patients were obtained: MP n = 128; SP n = 116; SS n = 118. The three groups were homogenous for the above-mentioned characteristics. Based on linear regression analysis, the SP group had shorter overall operative time (OT), length of stay (LOS) and lower estimated blood loss (EBL), although the latter in a non-clinically significant manner (5 mL). No differences between groups in 30-day Clavien-Dindo complications, conversion rate, 30-day reinterventions, 30-day readmission and 30-day mortality (p > 0.05). Conclusion: The analysis between robotic cholecystectomy methods showed that the SP technique results in lower LOS and EBL than the multiport technique. Regarding the duration of surgery, the SP technique was faster than the other two methods compared. SP robotic cholecystectomy is a safe and feasible alternative to multiport and single-site robotic surgery with promising results.