Clinical Outcomes of Laparoscopic vs Robotic-Assisted Cholecystectomy in Acute Care Surgery

Importance The use of robotic-assisted cholecystectomy in acute care surgery is increasing, but its safety and efficacy compared with laparoscopic cholecystectomy remain unclear. Objective To compare clinical outcomes and bile duct injury rates between robotic-assisted cholecystectomy and laparoscopic cholecystectomy in acute care surgery. Design, Setting, and Participants This was a retrospective cohort study using patient data from a commercial claims and encounter database from 2016 to 2021. Included in the study were adult patients undergoing robotic-assisted cholecystectomy or laparoscopic cholecystectomy in acute care surgery. Data were analyzed from January to October 2024. Exposures Robotic-assisted or laparoscopic cholecystectomy in acute care surgery. Main Outcomes and Measures The primary outcome was bile duct injury. Results A total of 844 428 patients (mean [SD] age, 45.6 [12.5] years; 547 665 female [64.9%]) were included in this analysis. After propensity score matching, robotic-assisted cholecystectomy (n = 35 037) and laparoscopic cholecystectomy (n = 35 037) had similar bile duct injury rates (0.37% [128 of 35 037] vs 0.39% [138 of 35 037]; odds ratio [OR], 0.93; 95% CI, 0.73-1.18; P = .54). Robotic-assisted cholecystectomy had higher major postoperative complications (8.37% [2934 of 35 037] vs 5.50% [1926 of 35 037]; OR, 1.57; 95% CI, 1.48-1.67; P < .001), more postoperative drain use (0.63% [219 of 35 037] vs 0.48% [132 of 35 037]; OR, 1.66; 95% CI, 1.34-2.07; P < .001), and longer median (IQR) hospital length of stay (3 [2-4] days vs 2 [1-4] days; P < .001). Conclusions and Relevance In this large, propensity-matched cohort analysis of acute care surgery cholecystectomy, robotic-assisted and laparoscopic cholecystectomy had similar bile duct injury rates, but robotic-assisted cholecystectomy was associated with higher postoperative complications, longer hospital stays, and increased drain use. Further research is needed to optimize the use of robotic-assisted cholecystectomy for acute gallbladder disease. These findings suggest that, under current practice conditions, robotic-assisted cholecystectomy may not offer clear benefits compared with the standard, established laparoscopic cholecystectomy approach.