Comments on ‘preliminary comparative outcomes of Versius robotic-assisted versus conventional laparoscopic cholecystectomy’

Dear Editor, We have read the article with great interest written by Oner M., ‘Comparison of Versius Robotic-assisted versus Conventional Laparoscopic Cholecystectomy’1 revealing an interesting perspective that compares robotic-assisted cholecystectomy versus traditional cholecystectomy, highlighting, of course, some of the differences that exist, thus contributing to further literature. The design, being retrospective in nature and conducted in a single centre by a sole operator, reduces operator variability but increases the potential for any underlying selection bias in the study design. The early adopters in robotic surgery have been shown in multiple studies across various disciplines to have been selectively adopted for less complex cases in assessing safety and efficiency measures. The protracted effects of the learning curve in influencing various surgical paradigms have been well documented in the literature in the early phases in multiple surgical disciplines.2 The median duration of operation for the Versius group was more than twice as long as the median duration for the laparoscopic group (54 min vs. 26 min, P ≤ 0.001), even though robotic cholecystectomy had been purported as being superior.2 The current data demonstrate that robotic cholecystectomy prolongs operative time and boosts costs without any reported clinical advantage.3 The lack of a cost-effectiveness assessment limits the overall utility for the conclusions drawn for this study. While these parameters showed statistically lower scores for robotic, it is postulated that hospital stay, with an identical median value for both groups, may not be clinically significant. Systematic reviews have shown that post-operative pain for robotic and traditional laparoscopic approaches differs minimally when both incisions and analgesics used are standardised.3,4 In summary, although this study supports the safety and feasibility of the Versius robotic system, we must conclude that this study lacks sufficient data verifying its advantage over traditional laparoscopy. Future studies should include larger, prospective studies with calculations for a learning curve and cost-effectiveness data that can more adequately determine the value of modular robotic cholecystectomy. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.