- Design
- Retrospective national registry cohort (ACS NSQIP)
- Population
- 85,774 adults with acute appendicitis, 807 robotic
- Primary outcome
- Operative time
- Effect
- Median 62 vs 44 min; conversion OR 2.4 (95% CI 1.11 to 5.20)
This NSQIP analysis, published 21 September, compared 807 robotic with about 85,000 laparoscopic appendicectomies for acute appendicitis in US adults in 2022–23.
Robotic cases took a median of 62 minutes against 44, and had 2.4 times the odds of conversion to open (95% CI 1.11 to 5.20). The time penalty grew with body mass index and was largest in perforated appendicitis. Robotic patients were older, heavier and more often had complicated disease, which the analysis adjusted for but cannot fully remove.
The abstract reports no clinical outcome in which the robot did better. In acute care, where theatre time is the scarce resource, that makes a strong case for keeping laparoscopy as the default.
- Keep laparoscopy as the default approach for acute appendicitis.
- Expect robotic cases to take about 18 minutes longer, more in obese patients and perforation.
- Robotic appendicectomy was associated with higher odds of conversion to open surgery.
- Reserve robotic access for training or specific indications, not routine emergency lists.
Why it matters
Asks whether robotic spread into emergency surgery reflects patient benefit or institutional preference.
Don't overread it
Registry data with selected, sicker robotic patients — the extra conversions may partly reflect case mix.
The statistics, in plain English
An odds ratio of 2.4 with a confidence interval of 1.11 to 5.20 is consistent with anything from a small to a large increase in conversion, because conversions were rare among only 807 robotic cases.
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