Da Vinci robot-assisted surgery for complex common bile duct stones: Efficacy and safety analysis—A retrospective study

To compare the safety and efficacy of da Vinci robot-assisted surgery versus conventional laparoscopic surgery for complex common bile duct stones, providing evidence-based medical evidence for optimal surgical approach selection. A single-center retrospective cohort study was conducted, analyzing clinical data of 109 patients with complex common bile duct stones who underwent surgical treatment at our Department of Hepatobiliary Surgery from January 2020 to January 2025. Patients were divided into observation group (da Vinci robot-assisted surgery, n=65) and control group (laparoscopic surgery, n=44) based on surgical approach. Baseline characteristics, surgery-related indicators (operative time, intraoperative blood loss, conversion to open surgery rate, intraoperative stone clearance completeness), safety indicators (intraoperative and postoperative complications, postoperative recovery indicators), and efficacy indicators (short-term efficacy, medium-to-long-term efficacy, quality of life scores) were compared between groups. No significant differences were found in baseline characteristics between groups (P>0.05), indicating comparability. Regarding surgery-related indicators: no significant difference in operative time was observed (P=0.342), while the observation group had significantly less intraoperative blood loss than the control group (15.2±5.8 mL vs 20.4±6.7 mL, P<0.001), lower conversion to open surgery rate (1.5% vs 9.1%, P=0.076, representing a trend toward lower conversion rate that warrants validation in larger studies), and higher intraoperative stone clearance completeness (98.5% vs 90.9%, P=0.048). For safety indicators: the observation group demonstrated significantly lower intraoperative complication rate (1.5% vs 9.1%, P=0.076) and early postoperative complication rate (3.1% vs 13.6%, P=0.043), shorter time to first flatus (18.7±6.2 h vs 22.3±8.1 h, P=0.009) and first ambulation (24.1±7.8 h vs 28.9±9.5 h, P=0.004), and lower postoperative pain scores at all time points. Regarding efficacy indicators: the observation group had significantly shorter liver function recovery time (P<0.001), and higher SF-36 quality of life scores in all dimensions at 6 months and 1 year postoperatively (P<0.05). Da Vinci robot-assisted surgery for complex common bile duct stones demonstrates significant technical advantages and clinical benefits while ensuring safety. It provides more precise surgical operations, reduces intraoperative bleeding, improves stone clearance completeness, promotes rapid postoperative recovery, and enhances patient quality of life, representing a promising option for complex hepatobiliary surgery.