New Technology and Bile Duct Injuries

Abstract

Thirty-five years ago, the rapid adoption of laparoscopic cholecystectomy ushered in the minimally invasive surgical revolution. Combining 2 preexisting and safe operations, this transformative innovation nonetheless resulted in unexpected patient harms: a significant increase in bile duct injuries during the learning curve. 1 Is history repeating itself with the introduction of robotic approaches? The advanced visualization, dexterity, and data analytics of robotic platforms may extend the benefits of minimally invasive surgery to highly complex procedures and perhaps enhance safety through future innovations like task automation, molecular imaging, and artificial intelligence-driven decision support. However, the rapid growth of robotic surgery in the United States is occurring in such common general surgical procedures as inguinal hernia and cholecystectomy, where traditional laparoscopic approaches already have excellent results.Kalata et al 2 now raise safety concerns about robotic compared with laparoscopic cholecystectomy. In an elegant study of Medicare administrative claims, robotic cholecystectomy was associated with a higher rate of severe bile duct injuries (0.72% vs 0.23%), postoperative biliary interventions (7.4% vs 6.0%), and serious complications (9.3% vs 8.6%). This pattern was consistent across sensitivity analyses and was mitigated in hospitals with a higher volume of robotic procedures, suggesting a learning-curve effect rather than selection of more difficult cases.The concern about increased complications associated with the learning curve for robotic cholecystectomy has been raised