ArticleJournal of robotic surgery2025
Robotic versus open repair of iatrogenic biliary duct injury: an international multicenter retrospective propensity score matched study.
Article in Journal of robotic surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Robotic repair of iatrogenic bile duct injuries (BDIs) has emerged as a promising alternative to the traditional open approach. However, current literature is limited to small single-center series. This international multicenter study aims to compare intraoperative and postoperative outcomes of robotic versus open surgical repair for bile duct injury across high-volume hepatobiliary centers. A retrospective analysis of 75 patients undergoing surgical repair for post-cholecystectomy BDIs between 2016 and 2024 was conducted across three tertiary hepatobiliary centers in the USA, Mexico, and Italy. Three separate 1:2 propensity score matching (PSM) analyses were conducted to compare (1) robotic vs. open repair, (2) early (≤ 7 days) vs. delayed repair, and (3) timing within the robotic cohort. Matching variables included age, gender, BMI, ASA score, injury complexity, and concomitant vascular injury. Outcomes included operative time, blood loss, complications, ICU/hospital stay, readmissions, biliary leak, stricture formation, and mortality. After PSM, 15 robotic and 28 open repairs were compared. Robotic repair was associated with significantly lower estimated blood loss (51 ± 39 vs. 314 ± 293 mL, p < 0.001) and shorter hospital stay (4 ± 1 vs. 16 ± 15 days, p < 0.001). No differences were observed in complication rates, biliary leak, or late strictures. Notably, two postoperative cardiopulmonary arrests unrelated to biliary reconstruction occurred in the robotic group. In subgroup analyses, robotic repair maintained favorable outcomes in both early and delayed settings. No bile leaks or strictures occurred within the robotic group. Delayed robotic repair was associated with longer operative time (337 ± 68 vs. 233 ± 46, p = 0.012), with similar complications or blood loss. Robotic reconstruction of iatrogenic BDIs is a safe and effective alternative to open surgery, offering reduced blood loss and faster recovery, even in complex vasculo-biliary reconstructions. These findings support its adoption in high-volume hepatobiliary centers and highlight the need for prospective studies to clarify its role in optimizing timing and long-term outcomes of biliary repair.
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