Outcomes are equivalent between robotic and laparoscopic cholecystectomy in all grades of acute cholecystitis.

Abstract

Robotic surgery is increasingly being adopted in emergency general surgery. The impact of robotic surgery on outcomes based on disease severity is unknown. We hypothesize that robotic cholecystectomy would be associated with better outcomes than laparoscopic cholecystectomy in severe acute cholecystitis. A single-center, retrospective analysis was conducted involving patients undergoing either laparoscopic or robotic cholecystectomy for acute cholecystitis from November 2022 to July 2024. Disease severity was categorized by the American Association for the Surgery of Trauma acute cholecystitis grading system (grade I, less severe; grade II-V, progressively more severe). Patients undergoing laparoscopic cholecystectomy were compared with those having robotic cholecystectomy. The primary outcome was the rate of intraoperative complications, including bile duct injury, vascular injury, hemorrhage requiring intraoperative blood transfusions, and bile or stone spillage. Secondary outcomes included need for subtotal cholecystectomy, conversion to open surgery, intraoperative drain placement, postoperative complications, unplanned return to the operating room, postoperative hospital length of stay, and 30-day readmissions. We analyzed 592 patients, of whom 476 (80.4%) had American Association for the Surgery of Trauma grade I cholecystitis, and the remaining 116 (19.6%) had grade II-V. Patient demographics and baseline comorbidities were similar among the groups. Regardless of grade, there were no differences in primary and secondary outcomes except for postoperative hospital length of stay. Postoperative hospital length of stay was longer in the American Association for the Surgery of Trauma grade II-V cholecystitis treated by laparoscopic cholecystectomy (2 days vs 1 day, P = .048); however, laparoscopic cholecystectomy was not an independent predictor for prolonged hospitalization (odds ratio, 1.079; 95% CI, 0.682-1.707; P = .745). Robotic cholecystectomy is not associated with better outcomes than laparoscopic cholecystectomy, regardless of disease severity.