Safety and feasibility of an endoscopic retrograde cholangiopancreatography robotic system in common bile duct stone: 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; six underwent biliary cannulation alone and 20 underwent stone extraction. For 20 cases with stone extraction, comparisons were performed using 1:1 propensity score matching with conventional ERCP performed by the same operator. The safety outcome was assessed by adverse events. Feasibility outcomes included technical success, procedural time, operator radiation exposure, and learning-curve characteristics. Results: After matching, adverse event rates were similar between groups. Post-ERCP pancreatitis occurred in 15.0% (3/20, robotic) and 10.0% (2/20, conventional) (p=1.000), 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 longer procedure time (36.6 vs 17.0 min; 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 appears safe and feasible, with high technical success and substantially reduced operator radiation exposure.