Robotic emergency cholecystectomy was linked to fewer bile duct injuries

Design

Retrospective cohort with 1:1 propensity score matching, US hospital database

Population

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

Primary outcome

Bile duct injury during admission and within 30 days

Effect

30-day: 0.06% vs 0.11%; OR 0.56 (95% CI 0.39–0.81), robotic vs laparoscopic

A retrospective cohort from the US Premier Healthcare Database included 522,629 adults having emergency or urgent cholecystectomy in 2019–2024. Robotic use rose from 4.2% to 29.7% of cases over that time. Propensity matching on patient, admission, surgeon and hospital factors produced 73,316 well-balanced pairs.

Robotic surgery was associated with fewer bile duct injuries during the admission (0.03% vs 0.05%; OR 0.55, 95% CI 0.32–0.94) and by 30 days (0.06% vs 0.11%; OR 0.56, 0.39–0.81). Conversion to open surgery was lower (0.7% vs 2.1%), as were bleeding and 30-day reoperation, while operating time was about 11 minutes longer. Readmissions did not differ.

The relative reduction is substantial, but the absolute difference is about five injuries per 10,000 operations. Administrative data cannot capture how inflamed the gallbladder was or who chose the robot, and robotic adopters may differ in experience. This is not a reason to change platform; it is a reason to keep the safety steps that prevent bile duct injury, whichever platform is used.

• Bile duct injury after emergency cholecystectomy was rare on both platforms: about 1 in 1,000 at 30 days laparoscopically.
• Achieve and document the critical view of safety before clipping or dividing any structure.
• Have a low threshold for subtotal cholecystectomy or a bail-out when anatomy cannot be defined.
• Where robotic access exists, it is a reasonable option in acute cases; this cohort does not show it is required.

Why it matters

Robotic emergency cholecystectomy is spreading fast, and this is the largest signal yet that it is at least not riskier.

Don't overread it

Observational administrative data — the lower injury rate may reflect who chose the robot, not the robot itself.

The statistics, in plain English

An odds ratio of 0.56 is a 44% relative reduction, but from a very small base: 6 versus 11 injuries per 10,000 operations. Propensity matching balances what was recorded, not unrecorded factors such as how difficult the gallbladder looked.

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