Design: Retrospective cohort, US state administrative databases, multilevel regression
Population: 384,617 adults with unscheduled cholecystectomy for acute cholecystitis, 2012–2021
Primary outcome: Bailout procedure (conversion, subtotal cholecystectomy or cholecystostomy)
Effect: 1.7% robotic vs 1.4% laparoscopic; adjusted OR 1.38 (95% CI 1.21 to 1.58); bile duct injury 1.6% in both

Using state discharge databases from New York and Florida, this retrospective study compared 384,617 emergency cholecystectomies for acute cholecystitis, 4% robotic and 96% laparoscopic, from 2012 to 2021. Bailout covered conversion to open, subtotal cholecystectomy or cholecystostomy.

Robotic surgery was associated with slightly more bailout (1.7% vs 1.4%; adjusted OR 1.38), more conversion and more subtotal cholecystectomy, but fewer cholecystostomy tubes. Bile duct injury was 1.6% in both groups. Among the 5,448 who needed a bailout, robotic cases needed fewer later endoscopic or surgical procedures. One-year costs were higher with robotic surgery (median $29,702 vs $24,483).

The higher subtotal rate may reflect surgeons using the robot for harder gallbladders, or being readier to bail out safely. It is administrative data, so severity is only partly captured.

For most units, laparoscopic cholecystectomy remains the standard for acute cholecystitis. A robot does not reduce bile duct injury in these data and costs more.

Laparoscopic cholecystectomy remains the standard for acute cholecystitis
Bile duct injury rates were the same with robotic and laparoscopic approaches
Subtotal cholecystectomy is a legitimate safe bailout, not a failure
Robotic surgery was linked to higher one-year cost without a safety gain

Why it matters

It tests the claim that robotic platforms make difficult emergency gallbladders safer.

The statistics, in plain English

An adjusted odds ratio of 1.38 means about 38% higher odds of bailout, but the absolute difference is small: 1.7% versus 1.4%. With 384,617 patients, even tiny differences reach significance, so the absolute numbers matter more.