Robotic vs Laparoscopic Cholecystectomy: Preoperative and Intraoperative Severity-Adjusted Outcomes with…

Cohort studyJournal of the American College of Surgeons· Aug 2026

Robotic vs Laparoscopic Cholecystectomy: Preoperative and Intraoperative Severity-Adjusted Outcomes with Strasberg-Classified Bile Duct Injury.

Omneya Kandil, Nisha Rehman, Andrew Saleeb … Irving Jorge

Hepatobiliary & Pancreatic SurgeryCohort studyTreatmentQ1IF 1.9

Robot-assisted cholecystectomy linked to lower odds of bile duct injury in acute cholecystitis

Robotic vs Laparoscopic Cholecystectomy: Preoperative and Intraoperative Severity-Adjusted Outcomes with Strasberg-Classified Bile Duct Injury.

Omneya Kandil … Irving Jorge

Journal of the American College of Surgeons · Aug 2026 · Q1 in Surgery

Background

Whether robot-assisted cholecystectomy reduces bile duct injury compared with laparoscopic cholecystectomy remains uncertain because prior studies have inadequately accounted for disease severity and have rarely classified injury severity using standardized criteria.

Purpose

This study compared perioperative outcomes after robot-assisted and laparoscopic cholecystectomy across a large healthcare system while adjusting for operative complexity.

Methods

Adults undergoing robot-assisted or laparoscopic cholecystectomy within the Mayo Clinic Enterprise (2014-2025) were retrospectively evaluated.

n = 23,513 patients

Results

robotic approach cut the risk of bile duct injury

AOR 0.29 (95% CI 0.07 to 0.78)

null 1

0.07

0.78

CI excludes the null - significant

More results

Among 23,513 patients (19,998 laparoscopic; 3,515 robotic), robot-assisted cholecystectomy was used more frequently for Parkland grade ≥3 disease.

Overall, 227 bile duct injuries occurred (204 laparoscopic; 23 robotic), corresponding to absolute risks of 1.02% and 0.65%, respectively (absolute risk difference -0.37%, 95% CI -0.72% to -0.02%; number needed to treat, 273).

More results

Robot-assisted cholecystectomy was associated with lower odds of conversion to open surgery, 30-day readmission, and mortality, shorter hospital stay (β -0.56, 95% CI -0.66 to -0.45; P<0.001), and a 5-minute longer median operative time.

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Conclusion

After adjustment for disease severity and surgeon-related factors, robot-assisted cholecystectomy was associated with lower odds of bile duct injury in acute cholecystitis and improved perioperative outcomes, including shorter hospitalization and lower conversion rates, despite greater use in more complex cases.

Robotic vs Laparoscopic Cholecystectomy: Preoperative and Intraoperative Severity-Adjusted Outcomes with Strasberg-Classified Bile Duct Injury.

Robotic vs Laparoscopic Cholecystectomy: Preoperative and Intraoperative Severity-Adjusted Outcomes with Strasberg-Classified Bile Duct Injury.

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