This cohort study compared robotic-assisted vs laparoscopic cholecystectomy in 863 patients at an academic hepatobiliary referral center (August 2018–August 2024), focusing on complex elective cholecystectomy (CEC) defined by prior aborted/partial cholecystectomy, cholecystostomy tube, or history of gallbladder perforation/fistula.
In CEC patients, laparoscopic approach was independently associated with 4× higher odds of unplanned endoscopic or percutaneous intervention vs robotic (OR 4.24; 95% CI 1.24–14.52; P=.02). Despite higher OR costs for robotic surgery, total cost of care was equivalent for CEC ($14,309 laparoscopic vs $14,476 robotic), but robotic non-CEC carried significantly higher total costs ($11,416 vs $9,925 laparoscopic).
Single academic hepatobiliary referral center limits generalizability. Retrospective cohort design carries inherent selection bias—robotic cases may have been selectively assigned to more experienced surgeons. The absolute number of CEC cases is not broken out, limiting power assessment.
For complex gallbladder disease (prior failed cholecystectomy, cholecystostomy tube, or fistula), consider robotic cholecystectomy to reduce downstream interventions without increasing total cost. Reserve robotic approach for high-complexity cases; in routine (non-CEC) cholecystectomy, laparoscopic surgery remains more cost-effective overall.
