- Design
- Retrospective cohort with 1:1 propensity score matching
- Population
- 522,629 US adults having emergency or urgent cholecystectomy, 2019 to 2024; 73,316 matched pairs
- Primary outcome
- Bile duct injury, index admission and 30 days
- Effect
- 30-day 0.06% vs 0.11%; OR 0.56 (95% CI 0.39 to 0.81)
A retrospective cohort from a large US hospital database examined 522,629 adults having emergency or urgent cholecystectomy between 2019 and 2024. Robotic use rose from 4.2% to 29.7% of cases over that time. Propensity matching on patient, admission, surgeon and hospital characteristics produced 73,316 pairs.
Robotic cholecystectomy was associated with fewer bile duct injuries during the admission (0.03% vs 0.05%; OR 0.55, 95% CI 0.32 to 0.94) and by 30 days (0.06% vs 0.11%; OR 0.56, 0.39 to 0.81). Conversion was lower (0.7% vs 2.1%), as were bleeding and reoperation, by small margins. Operating time was about 11 minutes longer, and readmission did not differ.
The absolute difference in bile duct injury is about 5 per 10,000 operations. Administrative data rely on coding, cannot see intraoperative difficulty, and cannot account for which surgeons and hospitals chose the robot for which patients. The authors themselves note residual confounding.
For most units, including nearly all Indian public hospitals, robotic access is not available for emergency gallbladder surgery, and the fundamentals that prevent bile duct injury apply whatever the platform: the critical view of safety and a low threshold for bailout.
- Bile duct injury was rare with either approach: about 1 in 900 laparoscopic and 1 in 1,700 robotic cases at 30 days.
- Do not delay an emergency cholecystectomy to obtain robotic access on the strength of this study.
- Achieve the critical view of safety before clipping, whatever the platform.
- Audit your own conversion and bile duct injury rates if your unit is adopting robotic emergency surgery.
- Expect about 11 extra minutes of operating time per case with the robot.
Why it matters
Robotic emergency surgery is spreading fast, and this is the largest signal yet that it may not trade safety for convenience.
Don't overread it
This is an observational database study; it cannot show the robot caused fewer injuries.
The statistics, in plain English
An odds ratio of 0.56 roughly halves the relative risk, but the baseline is tiny, so about 2,000 robotic operations would be needed to avoid one injury. Propensity matching balances the factors that were measured; it cannot balance surgeon skill or case selection that the database does not record.
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