Robotic Care Outcomes Project (ROBOCOP): Emergency Cholecystectomy and Bile Duct Injury.

Abstract

Background: Comparative bile duct injury (BDI) risk between robotic and laparoscopic cholecystectomy remains uncertain in contemporary emergency practice. We compared BDI and perioperative outcomes after robotic (RCHOLE) versus laparoscopic cholecystectomy (LCHOLE).

Study design: We conducted a retrospective cohort study of adults undergoing emergency or urgent cholecystectomy from 2019-2024 within the Premier Healthcare Database. Propensity scores incorporating patient, admission, surgeon, and hospital characteristics were used for 1:1 nearest-neighbor matching. Outcomes included index and 30-day BDI, conversion, perioperative complications, reoperation, and readmission. Conditional logistic regression evaluated BDI in matched pairs.

Results: Among 522,629 patients, 449,312 underwent LCHOLE and 73,317 RCHOLE; RCHOLE use increased from 4.2% in 2019 to 29.7% in 2024. Propensity score matching (PSM) yielded 73,316 patients per group with standardized mean differences <0.1. RCHOLE was associated with lower BDI during the index hospitalization (0.03% vs 0.05%; 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). RCHOLE also had lower conversion (0.7% vs 2.1%; p<0.001), bleeding (2.2% vs 2.6%; p<0.001), abdominal injuries (2.0% vs 2.4%; p<0.001), and 30-day reoperations (1.3% vs 1.5%; p<0.001), but longer operative time (120.7 vs 109.4 minutes; p<0.001). Readmission did not differ (4.5% vs 4.7%; p=0.14).

Conclusions: In this contemporary observational cohort, RCHOLE was associated with lower BDI, conversion, and selected perioperative complications than LCHOLE, with longer operative time. Residual confounding remains possible.