Robotic Cholecystectomy Linked to Higher Bailout Rates and Costs in Acute Cholecystitis

A retrospective cohort study in the Journal of the American College of Surgeons compared robotic and laparoscopic cholecystectomy for acute cholecystitis, including bailout procedures often excluded from previous comparisons. Researchers used New York and Florida Healthcare Cost and Utilization Project databases from 2012–2021, identifying 384,617 adults undergoing inpatient, unscheduled surgery; 4% underwent robotic procedures. Bailout comprised conversion to open surgery, subtotal cholecystectomy, or cholecystostomy tube placement. Outcomes and costs were assessed through 1 year.

Bailout occurred in 1.7% of robotic versus 1.4% of laparoscopic procedures (adjusted odds ratio 1.38, 95% CI 1.21–1.58). Robotic surgery was associated with higher odds of open conversion and subtotal cholecystectomy, but lower odds of cholecystostomy tube placement. Bile duct injury rates were 1.6% in both groups (p=0.998).

Among 5,448 patients requiring bailout, robotic surgery was associated with fewer postoperative endoscopic biliary interventions (3.1% versus 7.7%; p=0.007) and surgical interventions (2.3% versus 7.5%; p=0.002). Median 1-year cumulative costs remained higher with robotic surgery ($29,702 versus $24,483; p=0.002).

The findings suggest a trade-off between fewer downstream interventions after robotic bailout and higher costs, without a difference in bile duct injury rates. The retrospective, observational design cannot establish causality, and findings from inpatient, unscheduled procedures in two states may not generalize to other settings.