A Retrospective Analysis of Short-Term Outcomes of Robotic and Laparoscopic Cholecystectomy: First Indian Experience

A Retrospective Analysis of Short-Term Outcomes of Robotic and Laparoscopic Cholecystectomy: First Indian Experience | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Retrospective Analysis of Short-Term Outcomes of Robotic and Laparoscopic Cholecystectomy: First Indian Experience Udipta Ray, Rahul Dhar This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4217767/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background There has been a gradual adoption of general surgery robotic programs in India. However, we still do not have a single comparative study reporting the initial experience of robotic-assisted cholecystectomy (RC) compared to laparoscopic cholecystectomy (LC). This retrospective study is aimed at addressing this clinical data gap. Methods This is a retrospective medical chart review where data related to patient demographics, intraoperative and postoperative outcomes was collected. All patients underwent either RC or LC for gallstone disease, performed by a single surgeon from January 2020 to September 2023. Results A total of 100 cases (RC- 50, LC- 50) were collected. Baseline parameters like age, sex, body mass index (BMI), and co-morbidities were comparable. There were no conversions from the planned procedure in either of the groups (0% vs 0%). There were no intraoperative complications such as bleeding or common bile duct injury (0% vs 0%). The rates of surgical site infections were numerically lower in the robotic group, 2% vs 6% (P = 0.3099). There were no postoperative complications in the robotic group, whereas 1 patient in the laparoscopic group experienced port side bleeding (0% vs 2%, P = 0.3173). The mean length of hospital stay was 1 day in both groups. The mean pain score 24- hours after the surgery was 1.78 ± 0.68 in the robotic group and 3.3 ± 1.2 in the laparoscopic group (P = < 0.001). At 14 days post-surgery, these scores decreased in both the groups, the robotic group- mean 1 and the laparoscopic group – mean 2. None of the patients required opioid analgesics in the robotic group whereas 20% of patients in the laparoscopic group needed at least one dose of opioid analgesics (P = 0.0009). There were no re-operations reported in the robotic group, whereas the laparoscopic group reported 1 case. The 30-day mortality was nil in both groups. Conclusion RC is feasible in Indian settings. Compared to LC, it does not increase morbidity. The improvement in acute postoperative pain can potentially allow early ambulation and recovery. A larger multicentric study, comparing RC to LC in India will validate our initial experience. cholecystectomy laparoscopic robotic-assisted surgery pain Introduction Cholecystectomy is one of the most common general surgery procedures performed globally [ 1 ]. Since the 1990s, laparoscopic cholecystectomy (LC) has been the gold standard technique, offering significant improvement in morbidity, mortality, and hospital stay compared to the open approach [ 2 ]. From the early 2000s onwards, robotic surgery has also seen gradual adoption in both oncology as well as benign procedures. Robotic surgery provides enhanced wristed instrumentation and ergonomics, reduces tremors, and provides a stable 3D magnified visual field; potentially addressing some of the challenges encountered with laparoscopy [ 3 ]. It has been demonstrated in multiple studies that Robotic cholecystectomy (RC) does not increase the morbidity of patients, compared to laparoscopy, when surgeons are in their learning curve [ 1 , 4 , 5 ]. No difference, in terms of complications, has been reported in these studies. Beyond the learning curve of RC, recent systematic reviews and meta-analyses have reported comparable intraoperative and postoperative outcomes of RC and LC [ 1 , 6 ]. These studies report no significant difference in terms of intra- and postoperative complications, blood loss, surgical site infections, or conversions. The operating room time in the RC group has been longer in these studies. In addition, studies have reported for RC, improvement in cosmesis satisfaction scores, body image perception scores, and pain after surgery [ 7 , 8 ]. From an Indian standpoint, RC is still in its infancy and its efficacy in these settings is largely unknown. To the best of our knowledge, this is the first study that compares RC to the gold standard, LC. As an extension of the above statement, we aim to report India’s first experience of RC and compare its 30-day perioperative outcomes to LC. The comparison is between multiport RC to multiport LC. Methods The study was conducted at a tertiary care institute in Kolkata, West Bengal, India. A retrospective medical chart review for the period of January 2020 to September 2023 was performed for patients who underwent cholecystectomy using the laparoscopic or robotic approach for gallstone disease. Baseline characteristics like age, sex, body mass index (BMI), and co-morbidities were recorded. Intraoperative parameters like operating time, type of procedure (laparoscopic or robotic), and intraoperative complications were collected. Postoperative outcomes like the length of hospital stay, analgesic usage, postoperative pain, the incidence of surgical site infection or any other postoperative complications, rates of re-admissions, and re-operations were recorded from medical records. Pain was measured by the 0 to 10 Numerical Rating Scale (NRS) with a score of “0” indicating no pain and a score of “10” indicating the worst pain imaginable. The scale is one question and is easy to complete, easy to comprehend, reproducible, and can detect small changes in pain. The NRS was completed at 24 hours post-surgery and at 14 days post-surgery time points. The study was conducted following the ethical principles outlined in the latest version of the Helsinki Declaration, as well as the applicable good clinical practice guidelines, and ethical approval was granted by the Institutional Ethics Committee of the Fortis Hospital, Kolkata, West Bengal, India. All operations (robotic or laparoscopic) were performed using the standard techniques advocated by surgeon societies. Robotic surgery was performed using the Da Vinci Xi Surgical System using 4 ports (Intuitive Surgical, Sunnyvale, CA, USA). It consists of a 3D vision system and Endowrist instruments with 7 degrees of freedom to recreate dexterity and a range of movement for a high degree of precision and flexibility. A single skilled surgeon performed all the procedures, LC and RC. The statistical analysis of the quantitative variables was summarized as the arithmetic mean with standard deviation (SD). Frequencies and percentages were used to summarize categorical data. Pearson chi-square test or Fisher's exact test, as appropriate, was used to compare frequencies between the groups. The two-sample t-test was used to compare differences in means between the robotic-assisted and laparoscopic groups. A two-sided p < 0.05 was considered statistically significant. Statistical analysis was performed using Stata 16.0 statistical software (StataCorp LLC, Texas USA). Results Baseline characteristics A total of 100 cholecystectomy cases were collected, 50 each of RC and LC. Age, BMI, body surface area, American Society of Anesthesiologists Scale score, and number of patients with symptomatic gallbladder were not significantly different between the two groups. None of the patients had a previous history of upper abdominal surgery. Perioperative outcomes All 100 cases underwent cholecystectomy for gallstone disease. The intraoperative and postoperative outcomes are summarized in Table 1 . The total operating time was not adequately recorded in medical records and was not included in the study. There were no conversions from the planned procedure in either of the groups. There were no intraoperative complications such as bleeding or common bile duct injury. The rates of surgical site infections were numerically lower in the robotic group, 2% vs 6%. There were no postoperative complications in the robotic group, where 1 patient in the laparoscopic group experienced port side bleeding. The mean length of hospital stay was 1 day in both groups. The mean pain score at 24- hours after the surgery was 1.78 ± 0.68 in the robotic group and 3.3 ± 1.2 in the laparoscopic group. At 14 days post-surgery, these scores decreased in both the groups, the robotic group- mean 1 and the laparoscopic group – mean 2. None of the patients required opioid analgesics in the robotic group whereas 20% of patients in the laparoscopic group needed at least one dose of opioid analgesics. There were no re-operations reported in the robotic group, whereas the laparoscopic group reported 1 case. The 30-day mortality was nil in both groups. Table 1 Perioperative outcomes Variable Robotic-assisted (N = 50) Laparoscopic (N = 50) P-Value Total OT Time, mean ± SD, min 20.7 ± 3.84 18.82 ± 2.135 0.0032* Conversion, n (%) 0 (0) 0 (0) Intra-operative complications, n (%) 0 (0) 0 (0) Surgical site infection, n (%) 1 (2) 3 (6) 0.3099 Postoperative complications, n (%) 0 (0) 1 (2) 0.3173 Clavien-Dindo Classification of Postoperative complications, n (%) - Grade I 0 (0) 1 (2) 0.3173 Length of hospital stay, mean ± SD, days, mean 1 ± 0.00 1 ± 0.00 NA Pain Score at 24 hours post-surgery, mean ± SD 1.78 ± 0.68 3.3 ± 1.2 < 0.001* Pain Score at 14 days post-surgery, mean ± SD 1 ± 0.00 2 ± 0.0 NA Need for opioid analgesics, n (%) 0 (0) 10 (20) 0.0009* Re-admission within 30 days after surgery, n (%) 0 (0) 0 (0) - Reoperations, n (%) 0 (0) 1 (2) 0.3173 30-day mortality, n (%) 0 (0) 0 (0) - *Statistically significant; OT: Operating Room Time; SD: Standard Deviation Discussion RC has seen gradual adoption in Indian settings in the past 2 years. We undertook a retrospective medical chart review of 100 consecutive cholecystectomies, 50 patients each in the RC and LC group. We compared their first 30 days of perioperative clinical outcomes. For comparison, we do not have any comparative Indian studies and hence, we are relying on global clinical studies to compare our Indian experience. In terms of immediate perioperative clinical outcomes, we report comparable length of hospital stay and intra-operative and postoperative complications. There were no conversions in either group. Our findings are consistent with global literature. A 2023 systematic review of multiport LC and multiport RC included 14 studies and more than 3000 patients [ 1 ]. This study reported no difference in blood loss intra-operatively (weighted mean difference was − 6.73 ml, 95% CI − 16.31 to 2.84 ml for RC, with P = 0.17. The length of hospital stay was comparable, weighted mean difference of − 0.38, 95% CI − 0.87 to 0.12, and P = 0.13. There was no difference in overall postoperative complications, weighted odds ratio of 1.21 (95% CI − 0.80 to 1.84), with P = 0.86. Similarly, there was no significant difference in the incidence of bile duct injuries between the two groups, P = 0.46 [ 1 ]. We report significantly better pain scores at 24- hours post-surgery and 14 days post-surgery time points. These findings are similar to those of Lee and colleagues [ 8 ]. In this study, patients who underwent RC reported lesser pain compared to LC, at 6 hours, 24 hours post-surgery, 2 days post-surgery, and 1 week post-surgery time points [ 8 ]. However, this study compared single-port RC to multiport LC. A 2022 Korean study, comparing multiport RC to multiport LC reported significantly better pain scores in the RC group [ 9 ]. In this study, pain scores at 2, 4, and 8 h were significantly lower in the RC group (p = 0.04, 0.02, and 0.02, respectively) [ 9 ]. Also, the LC group received more analgesics after surgery (RC = 0.3 ± 0.5 vs. LC = 0.7 ± 0.9, p = 0.03). These are similar to our findings where none of the patients in the RC group needed opioid analgesics and 20% of patients in the LC group needed at least one dose of opioid analgesics. We observed an improving trend towards a lower incidence of surgical site infections (SSI). Studies have not reported a significant difference in rates of SSIs [ 7 , 10 , 11 ]. Kudsi et al found the rates to be 2.4% in the RC group and 1.9% in the LC group (P = Not significant), whereas Grochola and group reported an SSI rate of 3.3% in both RC and LC groups [ 10 ]. Our study presents the first India experience for RC. A prospective multicentric study will validate our findings and strengthen the existing evidence. Strengths and limitations Strengths: To the best of our knowledge, this is the first comparative study of RC and LC from India. This is also amongst a handful of global real-world studies comparing multiport RC to multiport LC. Only one expert surgeon performed and contributed cases to this study and thus there was uniformity in the operative techniques. Limitations : The retrospective design and lack of long-term follow-up did not allow reporting of medium to long-term results. We could not evaluate the quality of life due to the lack of such data in medical records. We were also unable to do a cost-effective analysis due to data limitations. Declarations CONFLICT OF INTEREST: The authors report no conflicts of interest in this work. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Funding: The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Financial Interests: The authors have no relevant financial or non-financial interests to disclose. Author Contributions: Udipta Ray contributed to the study conceptualization, formal analysis, and methodology. The first draft of the manuscript was written by Udipta Ray and all authors reviewed and edited the manuscript. All authors read and approved the final manuscript. Ethics Approval: This study was performed in line with the principles of the Declaration of Helsinki and the applicable guidelines for good clinical practice (GCP). The approval was granted by the Institutional Ethics Committee of the Fortis Hospital, Kolkata, West Bengal, India. Consent to Participate: Being a retrospective data collection study, the study data was collected in an anonymized fashion. Hence waiver of informed consent was applicable as per the regulatory guidelines. Consent to Publish: Not applicable References Straatman J, Pucher PH, Knight BC, et al. Systematic review: robot-assisted versus conventional laparoscopic multiport cholecystectomy. J Robot Surg. 2023;17(5):1967-1977. doi:10.1007/s11701-023-01662-3 Coccolini F, Catena F, Pisano M, et al. Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analysis [published correction appears in Int J Surg. 2015 Dec;24(Pt A):107]. Int J Surg. 2015;18:196-204. doi:10.1016/j.ijsu.2015.04.083 Toro JP, Lin E, Patel AD. Review of robotics in foregut and bariatric surgery. Surg Endosc. 2015;29(1):1-8. doi:10.1007/s00464-014-3646-z Jayaraman S, Davies W, Schlachta CM. Getting started with robotics in general surgery with cholecystectomy: the Canadian experience. Can J Surg. 2009;52(5):374-378. Kornprat P, Werkgartner G, Cerwenka H, et al. Prospective study comparing standard and robotically assisted laparoscopic cholecystectomy. Langenbecks Arch Surg. 2006;391(3):216-221. doi:10.1007/s00423-006-0046-4 Singh A, Kaur M, Swaminathan C, Siby J, Singh KK, Sajid MS. Laparoscopic versus robotic cholecystectomy: a systematic review with meta-analysis to differentiate between postoperative outcomes and cost-effectiveness. Transl Gastroenterol Hepatol. 2024;9:3. Published 2024 Jan 12. doi:10.21037/tgh-23-56 Kudsi OY, Castellanos A, Kaza S, et al. Cosmesis, patient satisfaction, and quality of life after da Vinci Single-Site cholecystectomy and multiport laparoscopic cholecystectomy: short-term results from a prospective, multicenter, randomized, controlled trial. Surg Endosc. 2017;31(8):3242-3250. doi:10.1007/s00464-016-5353-4 Lee EK, Park E, Oh WO, Shin NM. Comparison of the outcomes of robotic cholecystectomy and laparoscopic cholecystectomy [published correction appears in Ann Surg Treat Res. 2017 Oct;93(4):229]. Ann Surg Treat Res. 2017;93(1):27-34. doi:10.4174/astr.2017.93.1.27 Cho G, Yoo T, Chang W. Robotic cholecystectomy with a new port placement: Is it really beneficial?. Asian J Surg. 2022;45(8):1542-1546. doi:10.1016/j.asjsur.2021.09.016 Grochola LF, Soll C, Zehnder A, Wyss R, Herzog P, Breitenstein S. Robot-assisted versus laparoscopic single-incision cholecystectomy: results of a randomized controlled trial. Surg Endosc. 2019;33(5):1482-1490. doi:10.1007/s00464-018-6430-7 Pietrabissa A, Pugliese L, Vinci A, et al. Short-term outcomes of single-site robotic cholecystectomy versus four-port laparoscopic cholecystectomy: a prospective, randomized, double-blind trial. Surg Endosc. 2016;30(7):3089-3097. doi:10.1007/s00464-015-4601-3 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Since the 1990s, laparoscopic cholecystectomy (LC) has been the gold standard technique, offering significant improvement in morbidity, mortality, and hospital stay compared to the open approach [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. From the early 2000s onwards, robotic surgery has also seen gradual adoption in both oncology as well as benign procedures. Robotic surgery provides enhanced wristed instrumentation and ergonomics, reduces tremors, and provides a stable 3D magnified visual field; potentially addressing some of the challenges encountered with laparoscopy [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. It has been demonstrated in multiple studies that Robotic cholecystectomy (RC) does not increase the morbidity of patients, compared to laparoscopy, when surgeons are in their learning curve [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. No difference, in terms of complications, has been reported in these studies. Beyond the learning curve of RC, recent systematic reviews and meta-analyses have reported comparable intraoperative and postoperative outcomes of RC and LC [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. These studies report no significant difference in terms of intra- and postoperative complications, blood loss, surgical site infections, or conversions. The operating room time in the RC group has been longer in these studies.\u003c/p\u003e \u003cp\u003eIn addition, studies have reported for RC, improvement in cosmesis satisfaction scores, body image perception scores, and pain after surgery [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. From an Indian standpoint, RC is still in its infancy and its efficacy in these settings is largely unknown. To the best of our knowledge, this is the first study that compares RC to the gold standard, LC. As an extension of the above statement, we aim to report India\u0026rsquo;s first experience of RC and compare its 30-day perioperative outcomes to LC. The comparison is between multiport RC to multiport LC.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe study was conducted at a tertiary care institute in Kolkata, West Bengal, India. A retrospective medical chart review for the period of January 2020 to September 2023 was performed for patients who underwent cholecystectomy using the laparoscopic or robotic approach for gallstone disease. Baseline characteristics like age, sex, body mass index (BMI), and co-morbidities were recorded. Intraoperative parameters like operating time, type of procedure (laparoscopic or robotic), and intraoperative complications were collected. Postoperative outcomes like the length of hospital stay, analgesic usage, postoperative pain, the incidence of surgical site infection or any other postoperative complications, rates of re-admissions, and re-operations were recorded from medical records. Pain was measured by the 0 to 10 Numerical Rating Scale (NRS) with a score of \u0026ldquo;0\u0026rdquo; indicating no pain and a score of \u0026ldquo;10\u0026rdquo; indicating the worst pain imaginable. The scale is one question and is easy to complete, easy to comprehend, reproducible, and can detect small changes in pain. The NRS was completed at 24 hours post-surgery and at 14 days post-surgery time points. The study was conducted following the ethical principles outlined in the latest version of the Helsinki Declaration, as well as the applicable good clinical practice guidelines, and ethical approval was granted by the Institutional Ethics Committee of the Fortis Hospital, Kolkata, West Bengal, India.\u003c/p\u003e \u003cp\u003eAll operations (robotic or laparoscopic) were performed using the standard techniques advocated by surgeon societies. Robotic surgery was performed using the Da Vinci Xi Surgical System using 4 ports (Intuitive Surgical, Sunnyvale, CA, USA). It consists of a 3D vision system and Endowrist instruments with 7 degrees of freedom to recreate dexterity and a range of movement for a high degree of precision and flexibility. A single skilled surgeon performed all the procedures, LC and RC. The statistical analysis of the quantitative variables was summarized as the arithmetic mean with standard deviation (SD). Frequencies and percentages were used to summarize categorical data. Pearson chi-square test or Fisher's exact test, as appropriate, was used to compare frequencies between the groups. The two-sample t-test was used to compare differences in means between the robotic-assisted and laparoscopic groups. A two-sided p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. Statistical analysis was performed using Stata 16.0 statistical software (StataCorp LLC, Texas USA).\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eBaseline characteristics\u003c/h2\u003e \u003cp\u003eA total of 100 cholecystectomy cases were collected, 50 each of RC and LC. Age, BMI, body surface area, American Society of Anesthesiologists Scale score, and number of patients with symptomatic gallbladder were not significantly different between the two groups. None of the patients had a previous history of upper abdominal surgery.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003ePerioperative outcomes\u003c/h2\u003e \u003cp\u003eAll 100 cases underwent cholecystectomy for gallstone disease. The intraoperative and postoperative outcomes are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The total operating time was not adequately recorded in medical records and was not included in the study. There were no conversions from the planned procedure in either of the groups. There were no intraoperative complications such as bleeding or common bile duct injury. The rates of surgical site infections were numerically lower in the robotic group, 2% vs 6%. There were no postoperative complications in the robotic group, where 1 patient in the laparoscopic group experienced port side bleeding. The mean length of hospital stay was 1 day in both groups.\u003c/p\u003e \u003cp\u003eThe mean pain score at 24- hours after the surgery was 1.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68 in the robotic group and 3.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2 in the laparoscopic group. At 14 days post-surgery, these scores decreased in both the groups, the robotic group- mean 1 and the laparoscopic group \u0026ndash; mean 2. None of the patients required opioid analgesics in the robotic group whereas 20% of patients in the laparoscopic group needed at least one dose of opioid analgesics. There were no re-operations reported in the robotic group, whereas the laparoscopic group reported 1 case. The 30-day mortality was nil in both groups.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePerioperative outcomes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRobotic-assisted (N\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLaparoscopic (N\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal OT Time, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.82\u0026thinsp;\u0026plusmn;\u0026thinsp;2.135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.0032*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConversion, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntra-operative complications, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical site infection, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.3099\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative complications, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.3173\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClavien-Dindo Classification of Postoperative complications, n (%)\u003c/p\u003e \u003cp\u003e- Grade I\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.3173\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of hospital stay, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, days, mean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain Score at 24 hours post-surgery, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain Score at 14 days post-surgery, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeed for opioid analgesics, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.0009*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRe-admission within 30 days after surgery, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReoperations, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.3173\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30-day mortality, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003cp\u003e*Statistically significant; OT: Operating Room Time; SD: Standard Deviation\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eRC has seen gradual adoption in Indian settings in the past 2 years. We undertook a retrospective medical chart review of 100 consecutive cholecystectomies, 50 patients each in the RC and LC group. We compared their first 30 days of perioperative clinical outcomes. For comparison, we do not have any comparative Indian studies and hence, we are relying on global clinical studies to compare our Indian experience.\u003c/p\u003e \u003cp\u003eIn terms of immediate perioperative clinical outcomes, we report comparable length of hospital stay and intra-operative and postoperative complications. There were no conversions in either group. Our findings are consistent with global literature. A 2023 systematic review of multiport LC and multiport RC included 14 studies and more than 3000 patients [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This study reported no difference in blood loss intra-operatively (weighted mean difference was \u0026minus;\u0026thinsp;6.73 ml, 95% CI\u0026thinsp;\u0026minus;\u0026thinsp;16.31 to 2.84 ml for RC, with P\u0026thinsp;=\u0026thinsp;0.17. The length of hospital stay was comparable, weighted mean difference of \u0026minus;\u0026thinsp;0.38, 95% CI\u0026thinsp;\u0026minus;\u0026thinsp;0.87 to 0.12, and P\u0026thinsp;=\u0026thinsp;0.13. There was no difference in overall postoperative complications, weighted odds ratio of 1.21 (95% CI\u0026thinsp;\u0026minus;\u0026thinsp;0.80 to 1.84), with P\u0026thinsp;=\u0026thinsp;0.86. Similarly, there was no significant difference in the incidence of bile duct injuries between the two groups, P\u0026thinsp;=\u0026thinsp;0.46 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe report significantly better pain scores at 24- hours post-surgery and 14 days post-surgery time points. These findings are similar to those of Lee and colleagues [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In this study, patients who underwent RC reported lesser pain compared to LC, at 6 hours, 24 hours post-surgery, 2 days post-surgery, and 1 week post-surgery time points [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, this study compared single-port RC to multiport LC. A 2022 Korean study, comparing multiport RC to multiport LC reported significantly better pain scores in the RC group [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In this study, pain scores at 2, 4, and 8 h were significantly lower in the RC group (p\u0026thinsp;=\u0026thinsp;0.04, 0.02, and 0.02, respectively) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Also, the LC group received more analgesics after surgery (RC\u0026thinsp;=\u0026thinsp;0.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5 vs. LC\u0026thinsp;=\u0026thinsp;0.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9, p\u0026thinsp;=\u0026thinsp;0.03). These are similar to our findings where none of the patients in the RC group needed opioid analgesics and 20% of patients in the LC group needed at least one dose of opioid analgesics.\u003c/p\u003e \u003cp\u003eWe observed an improving trend towards a lower incidence of surgical site infections (SSI). Studies have not reported a significant difference in rates of SSIs [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Kudsi et al found the rates to be 2.4% in the RC group and 1.9% in the LC group (P\u0026thinsp;=\u0026thinsp;Not significant), whereas Grochola and group reported an SSI rate of 3.3% in both RC and LC groups [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Our study presents the first India experience for RC. A prospective multicentric study will validate our findings and strengthen the existing evidence.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eStrengths:\u003c/h2\u003e \u003cp\u003eTo the best of our knowledge, this is the first comparative study of RC and LC from India. This is also amongst a handful of global real-world studies comparing multiport RC to multiport LC. Only one expert surgeon performed and contributed cases to this study and thus there was uniformity in the operative techniques.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e\u003cb\u003eLimitations\u003c/b\u003e:\u003c/h2\u003e \u003cp\u003eThe retrospective design and lack of long-term follow-up did not allow reporting of medium to long-term results. We could not evaluate the quality of life due to the lack of such data in medical records. We were also unable to do a cost-effective analysis due to data limitations.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCONFLICT OF INTEREST:\u0026nbsp;\u003c/strong\u003eThe authors report no conflicts of interest in this work. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancial Interests:\u0026nbsp;\u003c/strong\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e Udipta Ray contributed to the study conceptualization, formal analysis, and methodology. The first draft of the manuscript was written by Udipta Ray and all authors reviewed and edited the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthics Approval:\u003c/strong\u003e This study was performed in line with the principles of the Declaration of Helsinki and the applicable guidelines for good clinical practice (GCP). The approval was granted by the Institutional Ethics Committee\u0026nbsp;of the Fortis Hospital, Kolkata, West Bengal, India.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate:\u0026nbsp;\u003c/strong\u003eBeing a retrospective data collection study, the study data was collected in an anonymized fashion. Hence waiver of informed consent was applicable as per the regulatory guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eStraatman J, Pucher PH, Knight BC, et al. Systematic review: robot-assisted versus conventional laparoscopic multiport cholecystectomy. J Robot Surg. 2023;17(5):1967-1977. doi:10.1007/s11701-023-01662-3\u003c/li\u003e\n\u003cli\u003eCoccolini F, Catena F, Pisano M, et al. Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analysis [published correction appears in Int J Surg. 2015 Dec;24(Pt A):107]. Int J Surg. 2015;18:196-204. doi:10.1016/j.ijsu.2015.04.083\u003c/li\u003e\n\u003cli\u003eToro JP, Lin E, Patel AD. Review of robotics in foregut and bariatric surgery. Surg Endosc. 2015;29(1):1-8. doi:10.1007/s00464-014-3646-z\u003c/li\u003e\n\u003cli\u003eJayaraman S, Davies W, Schlachta CM. Getting started with robotics in general surgery with cholecystectomy: the Canadian experience. Can J Surg. 2009;52(5):374-378.\u003c/li\u003e\n\u003cli\u003eKornprat P, Werkgartner G, Cerwenka H, et al. Prospective study comparing standard and robotically assisted laparoscopic cholecystectomy. Langenbecks Arch Surg. 2006;391(3):216-221. doi:10.1007/s00423-006-0046-4\u003c/li\u003e\n\u003cli\u003eSingh A, Kaur M, Swaminathan C, Siby J, Singh KK, Sajid MS. Laparoscopic versus robotic cholecystectomy: a systematic review with meta-analysis to differentiate between postoperative outcomes and cost-effectiveness. Transl Gastroenterol Hepatol. 2024;9:3. Published 2024 Jan 12. doi:10.21037/tgh-23-56\u003c/li\u003e\n\u003cli\u003eKudsi OY, Castellanos A, Kaza S, et al. Cosmesis, patient satisfaction, and quality of life after da Vinci Single-Site cholecystectomy and multiport laparoscopic cholecystectomy: short-term results from a prospective, multicenter, randomized, controlled trial. Surg Endosc. 2017;31(8):3242-3250. doi:10.1007/s00464-016-5353-4\u003c/li\u003e\n\u003cli\u003eLee EK, Park E, Oh WO, Shin NM. Comparison of the outcomes of robotic cholecystectomy and laparoscopic cholecystectomy [published correction appears in Ann Surg Treat Res. 2017 Oct;93(4):229]. Ann Surg Treat Res. 2017;93(1):27-34. doi:10.4174/astr.2017.93.1.27\u003c/li\u003e\n\u003cli\u003eCho G, Yoo T, Chang W. Robotic cholecystectomy with a new port placement: Is it really beneficial?. Asian J Surg. 2022;45(8):1542-1546. doi:10.1016/j.asjsur.2021.09.016\u003c/li\u003e\n\u003cli\u003eGrochola LF, Soll C, Zehnder A, Wyss R, Herzog P, Breitenstein S. Robot-assisted versus laparoscopic single-incision cholecystectomy: results of a randomized controlled trial. Surg Endosc. 2019;33(5):1482-1490. doi:10.1007/s00464-018-6430-7\u003c/li\u003e\n\u003cli\u003ePietrabissa A, Pugliese L, Vinci A, et al. Short-term outcomes of single-site robotic cholecystectomy versus four-port laparoscopic cholecystectomy: a prospective, randomized, double-blind trial. Surg Endosc. 2016;30(7):3089-3097. doi:10.1007/s00464-015-4601-3\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"cholecystectomy, laparoscopic, robotic-assisted surgery, pain","lastPublishedDoi":"10.21203/rs.3.rs-4217767/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4217767/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThere has been a gradual adoption of general surgery robotic programs in India. However, we still do not have a single comparative study reporting the initial experience of robotic-assisted cholecystectomy (RC) compared to laparoscopic cholecystectomy (LC). This retrospective study is aimed at addressing this clinical data gap.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e This is a retrospective medical chart review where data related to patient demographics, intraoperative and postoperative outcomes was collected. All patients underwent either RC or LC for gallstone disease, performed by a single surgeon from January 2020 to September 2023.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 100 cases (RC- 50, LC- 50) were collected. Baseline parameters like age, sex, body mass index (BMI), and co-morbidities were comparable. There were no conversions from the planned procedure in either of the groups (0% vs 0%). There were no intraoperative complications such as bleeding or common bile duct injury (0% vs 0%). The rates of surgical site infections were numerically lower in the robotic group, 2% vs 6% (P\u0026thinsp;=\u0026thinsp;0.3099). There were no postoperative complications in the robotic group, whereas 1 patient in the laparoscopic group experienced port side bleeding (0% vs 2%, P\u0026thinsp;=\u0026thinsp;0.3173). The mean length of hospital stay was 1 day in both groups. The mean pain score 24- hours after the surgery was 1.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68 in the robotic group and 3.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2 in the laparoscopic group (P\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;0.001). At 14 days post-surgery, these scores decreased in both the groups, the robotic group- mean 1 and the laparoscopic group \u0026ndash; mean 2. None of the patients required opioid analgesics in the robotic group whereas 20% of patients in the laparoscopic group needed at least one dose of opioid analgesics (P\u0026thinsp;=\u0026thinsp;0.0009). There were no re-operations reported in the robotic group, whereas the laparoscopic group reported 1 case. The 30-day mortality was nil in both groups.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eRC is feasible in Indian settings. Compared to LC, it does not increase morbidity. The improvement in acute postoperative pain can potentially allow early ambulation and recovery. A larger multicentric study, comparing RC to LC in India will validate our initial experience.\u003c/p\u003e","manuscriptTitle":"A Retrospective Analysis of Short-Term Outcomes of Robotic and Laparoscopic Cholecystectomy: First Indian Experience","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-12 09:10:31","doi":"10.21203/rs.3.rs-4217767/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0079c90d-ce69-43ca-a2d4-5dbcdf70b304","owner":[],"postedDate":"April 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-14T01:29:28+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-12 09:10:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4217767","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4217767","identity":"rs-4217767","version":["v1"]},"buildId":"cTy_lsJlmDsVRNrSptgXS","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}