Robotic emergency cholecystectomy was associated with about half the bile duct injury rate of laparoscopy

Design

Retrospective propensity-matched cohort, US hospital database

Population

146,632 matched adults having emergency or urgent cholecystectomy, 2019 to 2024

Primary outcome

Bile duct injury at index admission and 30 days

Effect

30-day bile duct injury 0.06% vs 0.11%, OR 0.56 (95% CI 0.39 to 0.81); conversion 0.7% vs 2.1%

A retrospective cohort study in the Journal of the American College of Surgeons, published on 12 October, used a large US hospital database to compare robotic and laparoscopic cholecystectomy performed as emergency or urgent operations between 2019 and 2024. Robotic use rose from 4.2% to 29.7% of cases over the period. After propensity matching on patient, admission, surgeon and hospital factors, 73,316 patients were compared in each group.

Bile duct injury within 30 days was 0.06% after robotic surgery and 0.11% after laparoscopy (OR 0.56, 95% CI 0.39 to 0.81). Conversion to open was 0.7% vs 2.1%, and bleeding and 30-day reoperation were slightly lower. Robotic operations took about 11 minutes longer. Readmission did not differ.

Bile duct injury is rare in both arms, so the absolute difference is about five injuries per 10,000 operations. Database coding of bile duct injury is imperfect, and surgeons and hospitals that adopt robotics early may differ in ways matching cannot capture; the authors acknowledge residual confounding.

In India, robotic platforms are concentrated in a few centres and most emergency cholecystectomies are laparoscopic. The finding is not a reason to transfer an acute gallbladder; it is a reminder that the safety gain, if real, is small next to the gain from a disciplined critical view of safety.

• Count bile duct injury as a rare event in either approach — about 1 per 1,000 laparoscopic emergency cases in this database.
• Do not delay or transfer an emergency cholecystectomy solely to obtain a robotic platform.
• Plan for longer theatre time if a robotic approach is used — about 11 minutes more here.
• Have a low threshold for subtotal cholecystectomy or conversion when the anatomy cannot be defined, whatever the platform.

Why it matters

Robotic emergency gallbladder surgery is spreading fast, and this is the largest comparison of its safety so far.

Don't overread it

This was observational database work; it cannot show that the robot itself prevented the injuries.

The statistics, in plain English

An odds ratio of 0.56 means the odds of injury were roughly halved, and the interval (0.39 to 0.81) excludes 1. But with injury rates near 0.1%, halving them prevents about five injuries per 10,000 operations. Matching balances measured factors only; unmeasured differences between robotic and laparoscopic surgeons may remain.

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