Robotic-Assisted Common Bile Duct Exploration for Choledocholithiasis: A Systematic Review and Meta-Analysis of Efficacy and Safety Outcomes

TL;DR

Robotic-assisted bile duct surgery is effective for removing gallstones and has fewer complications than open surgery, though it takes longer.

Contribution

This study provides a systematic review and meta-analysis of robotic-assisted common bile duct exploration outcomes compared to other surgical methods.

Findings

RACBDE achieved a 95% pooled stone clearance rate with a 25% complication rate.

RACBDE had 34% lower complication risk than open surgery but took 37 minutes longer.

Complication rates for RACBDE decreased slightly over time but not significantly.

Abstract

Robotic-assisted common bile duct exploration (RACBDE) shows promise as a minimally invasive option, offering better outcomes over traditional approaches. This study reviews current evidence on RACBDE outcomes and, where possible, compares it to other surgical procedures. A comprehensive search was conducted across Ovid MEDLINE, EMBASE, Cochrane, and Scopus. We reviewed 346 studies published in the last 15 years, of which eight met the inclusion criteria. Eligible studies reported safety outcomes and efficacy of RACBDE for choledocholithiasis. Studies comparing RACBDE to other modalities (endoscopic retrograde cholangiopancreatography (ERCP), laparoscopy, and open surgery) were included for comparative meta-analysis. A total of 438 patients were included. Using a random effects model, single-arm analysis of eight datasets revealed an overall pooled stone clearance rate of 95% (95% CI: 0.90, 0.98; I² = 9.16%), while the overall pooled complication rate was 25% (95% CI: 0.17, 0.33; I² = 43.45%). Comparative analysis of three datasets revealed that RACBDE had a 34% lower risk of complications compared to open surgery (log risk ratio (RR): -0.42; 95% CI: -0.78 to -0.06; p < 0.05). However, open surgery had a 37-minute shorter operation time (mean difference (MD): 37.71 minutes; 95% CI: 15.28-60.13; p < 0.05). Meta-regression with the year as a covariate showed a 0.7% reduction in the complication rate per year with RABCDE; however, this was not statistically significant (coefficient: -0.00679; p = 0.37). This study suggests that RACBDE is highly effective for stone clearance with an acceptable complication rate. Compared to open surgery, RACBDE is linked to a significantly lower complication rate but longer operative times.

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