Design: Retrospective cohort, state inpatient and ambulatory databases (New York, Florida)
Population: 384,617 adults with unscheduled cholecystectomy for acute cholecystitis, 2012–2021
Primary outcome: Bailout procedures (conversion, subtotal cholecystectomy, cholecystostomy)
Effect: 1.7% vs 1.4%, aOR 1.38 (95% CI 1.21–1.58); bile duct injury 1.6% vs 1.6%

Using state inpatient data from New York and Florida between 2012 and 2021, this study compared 384,617 unscheduled cholecystectomies for acute cholecystitis, 4% robotic and 96% laparoscopic. Bailout was counted as conversion to open, subtotal cholecystectomy or cholecystostomy tube.

Bailout was slightly more common with robotic surgery (1.7% vs 1.4%; adjusted odds ratio 1.38), with more conversions and more subtotal cholecystectomies but fewer cholecystostomy tubes. Bile duct injury was identical at 1.6%. Among the 5,448 patients who needed a bailout, those operated robotically needed fewer later endoscopic and surgical interventions. Median one-year costs were about 5,200 US dollars higher with robotic surgery.

This is administrative data: case difficulty, surgeon experience and the learning curve during robotic adoption are not captured, and robotic cases may have been selected differently. It gives no reason to believe robotic surgery makes acute cholecystitis safer for the bile duct, and for Indian units weighing robotic acquisition, the cost gap will be larger in relative terms. It was published on 28 September 2026.

Robotic cholecystectomy did not reduce bile duct injury in acute cholecystitis in this dataset.
Bailout was slightly more frequent robotically, mostly as subtotal cholecystectomy and conversion.
After a bailout, robotic patients needed fewer later biliary interventions; this finding is based on a small subgroup.
One-year costs were higher robotically; factor this into case selection.
Choose the approach you and your team are most experienced with for a difficult gallbladder.

Why it matters

Robotic use for emergency gallbladder surgery is rising faster than the evidence for it.

The statistics, in plain English

An adjusted odds ratio of 1.38 sounds large, but the absolute difference in bailouts is 0.3 percentage points. Bile duct injury was 1.6% in both groups, so there is no signal either way. Observational comparisons of a new technique are vulnerable to selection: surgeons may choose robotic surgery for different patients.