Background and objectives: Laparoscopic cholecystectomy has remained the gold standard approach for gallbladder surgery for nearly 3 decades. However, adoption of robotics for treatment of gallbladder disease continues to grow. Despite this growth, clinical outcomes regarding laparoscopic versus robotic cholecystectomy remain unclear.
Methods: We conducted a multihospital retrospective cohort study of patients who underwent cholecystectomy between August 1, 2021 and November 30, 2023. We compared demographic and clinical characteristics, surgical details, and postoperative outcomes between laparoscopic and robotic groups. The postoperative outcomes analyzed included conversion to open, bile leak, major duct injury, return to the operating room, surgical site infection, blood transfusion, readmission, and death. The overall complication rate included any of these outcomes. Statistical analysis included χ2 tests, t-tests, Wilcoxon rank sum tests, and multivariable logistic regression. Most cases in the robotic group were elective (76.4% vs 58.5%, P < .001) and the robotic group utilized indocyanine green much more frequently (79.8% vs 4.5%, P < .001).
Results: A total of 4,316 patients were analyzed (3,736 laparoscopic, 580 robotic). In bivariate analyses, robotic surgery was associated with lower rates of conversion to open (P = .019), bleeding requiring transfusion (P = .017), and overall complications (2.9% vs 5.5%), respectively (P = .009). Robotic approach was associated with a 5 minute longer average surgery time (P = .002). Using multivariable logistic regression analysis to account for preoperative differences between the groups, robotic surgery was associated with a 62% decreased risk of any complication (odds ratio [OR] = 0.38, 95% confidence interval [CI] [0.20, 0.74]).
Conclusion: Robotic cholecystectomy demonstrates favorable clinical outcomes compared to laparoscopic cholecystectomy. These findings support the advantages of robotic assistance during cholecystectomy. To our knowledge, this represents one of the largest retrospective studies showing a clinical benefit from the robotic approach.
