Robotic Emergency Cholecystectomy Associated With Lower Bile Duct Injury Risk

The ROBOCOP retrospective cohort study examined bile duct injury and perioperative outcomes among adults undergoing emergency or urgent cholecystectomy in the Premier Healthcare Database from 2019–2024. Of 522,629 patients, 73,317 underwent robotic and 449,312 laparoscopic surgery. Propensity matching incorporating patient, admission, surgeon, and hospital characteristics yielded 73,316 patients per group. Robotic use increased from 4.2% in 2019 to 29.7% in 2024.

In matched analyses, robotic surgery was associated with lower bile duct injury rates during the index hospitalization (0.03% vs 0.05%; odds ratio [OR], 0.55; 95% CI, 0.32–0.94) and through 30 days (0.06% vs 0.11%; OR, 0.56; 95% CI, 0.39–0.81).

Robotic surgery also had lower rates of conversion (0.7% vs 2.1%), bleeding (2.2% vs 2.6%), abdominal injuries (2.0% vs 2.4%), and 30-day reoperation (1.3% vs 1.5%). Operative time was longer (120.7 vs 109.4 minutes); all these differences had p<0.001. Readmission rates did not differ significantly (4.5% vs 4.7%; p=0.14).

These findings inform comparisons of surgical approaches in urgent and emergency practice, although absolute bile duct injury rates were low in both groups. The observational design cannot establish causality, and residual confounding remains possible despite propensity matching.