The robotic era: 11-year retrospective study of cholecystectomies at a veterans affairs hospital.

Background: Robotic surgery has been proposed as an approach to mitigate open surgery, which is associated with increased morbidity and worse outcomes when compared to minimally invasive cholecystectomies. The study objective was to determine the effect on conversion rates and outcomes following the adoption of robotic surgery for benign gallbladder disease in a high-risk population.

Methods: Patients ≥ 18 years of age who underwent cholecystectomy for benign gallbladder disease from January 1, 2013 to April 18, 2025 at a Veterans Affairs hospital were retrospectively identified. Primary outcome was rate of conversion to open surgery. Secondary outcomes included post-operative complications and 30-day re-admissions and emergency department visits. Outcomes were compared between surgical approach eras and between robotic and non-robotic cohorts. Univariate and multivariate analysis were performed adjusting for patient factors, surgical factors, and diagnosis.

Results: 636 patients (median [IQR], 61 [46, 70] years; 86.0% male) underwent a cholecystectomy most commonly for acute cholecystitis (33.2% of surgical indications). 34.4% of patients underwent surgery during the pre-robotic era, 39.2% during the transition era, and 26.4% during the robotic era. Conversion rates decreased over time (14.6% pre-robotic, 4.0% transition, and 0.0% robotic era; p <  0.001). No conversions occurred during robotic cholecystectomy. Odds ratios of composite post-operative complications, 30-day readmissions, and 30-day emergency department visits by era were similar.

Conclusions: Following adoption of robotic cholecystectomy for benign gallbladder disease, conversion to open and primary open surgery were safely eradicated. Use of robotic surgery for patients at highest risk for conversion or with severe disease should be considered.