Afif N Kulaylat1, Holden Richards2, Keigo Yada3, David Coyle4, Rita Shelby5, Amanda J Onwuka6, Jennifer H Aldrink7, Karen A Diefenbach7, Marc P Michalsky7. 1. Division of Pediatric Surgery, Penn State Children's Hospital, Hershey, PA, United States. Electronic address: akulaylat@pennstatehealth.psu.edu. 2. Oregon Health and Science University School of Medicine, Portland, OR, United States. 3. Department of Pediatric Surgery, St. Luke's International Hospital, Tokyo, Japan. 4. Children's Health Ireland, Crumlin, Ireland. 5. Department of Surgery, Ohio State Wexner Medical Center, Columbus, OH, United States. 6. Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States. 7. Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, United States.
Abstract
BACKGROUND: Despite increased utilization of robotic-assisted surgery in the pediatric population during the past decade, reports of comparative analysis between robotic surgery and laparoscopic surgery are lacking. Our aim was to evaluate outcomes between pediatric robotic-assisted cholecystectomy (RC) and laparoscopic cholecystectomy (LC). METHODS: A single institution retrospective analysis of 299 patients undergoing either RC or LC, between January 2015 and December 2018 was performed. Demographic data as well as clinical characteristics and related outcomes were abstracted and compared using univariate analysis. Related hospital costs were estimated using a charge to cost methodology. RESULTS: The median age of the cohort was 15.5 years (IQR 14.0-17.0); 76% females and 70% white, with 74% (n = 220) undergoing LC and 26% (n = 79) undergoing RC. The majority of RC were performed using single-site technique and RC proportion increased with time (10% in 2015 vs. 41% in 2018, p<0.001). The majority of RC were more commonly attributed to patients with nonacute indications for cholecystectomy compared to acute clinical indications (87% vs. 13%). Median operative time was 98 min vs. 79 min for RC and LC respectively (p<0.001). Median postoperative LOS was similar between groups (22 h). There were no significant differences in postoperative complication, in-hospital opioid utilization and 30-day readmissions. Average total hospital costs for RC were $15,519 compared to $11,197 for LC. CONCLUSIONS: Pediatric robotic-assisted cholecystectomy is feasible with similar outcomes compared to laparoscopic cholecystectomy. However, it is associated with longer operative times and higher costs. The single-site RC technique may provide a potential cosmetic benefit.
BACKGROUND: Despite increased utilization of robotic-assisted surgery in the pediatric population during the past decade, reports of comparative analysis between robotic surgery and laparoscopic surgery are lacking. Our aim was to evaluate outcomes between pediatric robotic-assisted cholecystectomy (RC) and laparoscopic cholecystectomy (LC). METHODS: A single institution retrospective analysis of 299 patients undergoing either RC or LC, between January 2015 and December 2018 was performed. Demographic data as well as clinical characteristics and related outcomes were abstracted and compared using univariate analysis. Related hospital costs were estimated using a charge to cost methodology. RESULTS: The median age of the cohort was 15.5 years (IQR 14.0-17.0); 76% females and 70% white, with 74% (n = 220) undergoing LC and 26% (n = 79) undergoing RC. The majority of RC were performed using single-site technique and RC proportion increased with time (10% in 2015 vs. 41% in 2018, p<0.001). The majority of RC were more commonly attributed to patients with nonacute indications for cholecystectomy compared to acute clinical indications (87% vs. 13%). Median operative time was 98 min vs. 79 min for RC and LC respectively (p<0.001). Median postoperative LOS was similar between groups (22 h). There were no significant differences in postoperative complication, in-hospital opioid utilization and 30-day readmissions. Average total hospital costs for RC were $15,519 compared to $11,197 for LC. CONCLUSIONS: Pediatric robotic-assisted cholecystectomy is feasible with similar outcomes compared to laparoscopic cholecystectomy. However, it is associated with longer operative times and higher costs. The single-site RC technique may provide a potential cosmetic benefit.
Authors: Carlos Theodore Huerta; Andrew Sundin; Antoine J Ribieras; Rebecca Saberi; Walter Ramsey; Gareth Gilna; Hallie J Quiroz; Chad M Thorson; Juan E Sola; Eduardo A Perez Journal: Pediatr Surg Int Date: 2022-08-03 Impact factor: 2.003