Safety and feasibility of an ERCP robotic system in patients with common bile duct stones: a propensity score-matched observational study

Background: Robotic assistance may mitigate occupational hazards associated with endoscopic retrograde cholangiopancreatography (ERCP). We evaluated the safety, feasibility, and learning curve of a new ERCP robotic system. Methods: In this observational study, 26 patients with common bile duct stones underwent robotic-assisted ERCP; 6 underwent biliary cannulation only and 20 underwent stone extraction. For the 20 cases with stone extraction, comparisons were performed using 1:1 propensity score matching (PSM) with conventional ERCP performed by the same operator. The safety outcome was adverse events. Feasibility outcomes included technical success, procedural times, operator radiation exposure, and learning-curve characteristics. Results: After PSM, adverse event rates were similar between groups. Post-ERCP pancreatitis occurred in 15.0% (3/20, robotic) and 10.0% (2/20, conventional) (P >0.99), with no bleeding, perforation, or procedure-related mortality. Biliary cannulation and stone extraction success rates were 100% (20/20) in both groups. Robotic-assisted ERCP had a longer procedure time (36.6 vs. 17.0 minutes; P < 0.001), but similar cannulation and fluoroscopy times. In robotic-assisted procedures, radiation exposure was markedly lower in the control room than in the operation room (0.10 vs. 1.26 μSv; P < 0.001). Learning-curve analysis suggested performance stabilization after 10-12 cases. Conclusions: Robotic-assisted ERCP appeared safe and feasible, with high technical success and substantially reduced operator radiation exposure.