- Design
- Retrospective single-centre cohort
- Population
- 863 patients undergoing cholecystectomy, including complex elective cases
- Primary outcome
- Unplanned postoperative ERCP or interventional radiology procedure
- Effect
- Laparoscopic vs robotic in complex cases OR 4.24 (95% CI 1.24 to 14.52)
A single academic hepatobiliary centre reviewed 863 cholecystectomies from 2018 to 2024. Complex elective cholecystectomy was defined before surgery: a previous aborted or partial cholecystectomy, a cholecystostomy tube, or a history of perforation or fistula.
In complex cases, the laparoscopic approach was associated with more unplanned ERCP or interventional radiology procedures than robotic (OR 4.24, 95% CI 1.24 to 14.52). Theatre costs were higher for robotic surgery, but total cost of care was similar for complex cases ($14,309 vs $14,476). In straightforward gallbladders there was no outcome difference, and robotic surgery cost more overall.
The practical reading is narrow: if a unit has a robot, the defensible place for it in gallbladder surgery is the patient who has already had a drain or a failed attempt, not the routine list.
- Flag complex gallbladders before the list: previous subtotal, cholecystostomy tube, perforation, fistula.
- Plan these cases with a senior surgeon, whatever the platform.
- Do not use this study to justify robotic routine cholecystectomy — it cost more with no benefit.
- In Indian practice, where robotic access is limited, the stronger message is to plan complex cases deliberately.
Why it matters
It gives a specific, pre-operative definition of which gallbladders might justify a costlier platform.
Don't overread it
This was a single-centre cohort, not a trial; surgeons chose the approach, and the wide interval allows a much smaller difference.
The statistics, in plain English
An odds ratio of 4.24 sounds large, but its interval runs from 1.24 to 14.52, which reflects few events. One centre, one team and a non-randomised choice of approach limit how far it travels.
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