Initial experience with robotic-assisted resection for suspected or confirmed gallbladder cancer - comparison with open technique in a single centre retrospective observational cohort study.

Background and aim: Robotic-assisted surgery has become increasingly common and is now the gold standard for many procedures. In hepato-pancreato-biliary surgery, it has shown promise but remains insufficiently studied. This study reports our initial experience with robotic-assisted radical cholecystectomy for suspected or confirmed gallbladder cancer. The primary objective was to compare hospital length-of-stay - used as a proxy for functional recovery - between robotic-assisted and open surgery. The secondary objective was to assess surgical quality by comparing the number of retrieved lymph nodes.

Methods: All patients with suspected or confirmed gallbladder cancer accepted for radical cholecystectomy at Karolinska University Hospital between January 2019 and December 2022 were reviewed. Ninety-five patients were identified; 22 were excluded. Of the remaining 73, 23 underwent robotic-assisted surgery and 50 underwent open surgery.

Results: Robotic-assisted surgery was associated with shorter hospital stays: a median of four days compared to seven days for open surgery (p < 0.001). The number of retrieved lymph nodes was low in both groups but lower in the robotic group (median 1 vs. 3, p = 0.013). No difference regarding severe complications, readmissions or positive margin resections was found.

Conclusion: In this single-centre retrospective observational study, robotic-assisted radical cholecystectomy was associated with faster recovery compared to open surgery. To confirm these findings, a multi-centre randomized clinical trial has been initiated (ClinicalTrials.gov NCT06246448).