Robotic surgery may pay off in complex gallbladder cases

Clinical takeaway: Consider reserving robotic cholecystectomy for patients with complex gallbladder pathology, in whom fewer postoperative biliary interventions may offset the platform’s higher procedural costs.

As robotic cholecystectomy use expands, surgeons and health systems are under pressure to demonstrate better outcomes without raising overall costs. This study suggests robotics may offer its greatest value in the most technically challenging gallbladder cases.

Researchers compared robotic-assisted and laparoscopic cholecystectomy among 863 patients treated at an academic hepatobiliary referral center from August 2018 through August 2024. Complex elective cases included patients with a previous aborted or partial cholecystectomy, a cholecystostomy tube, or a history of gallbladder perforation or fistula. The cohort had a median age of 61 years, and approximately 61% were women.

Among patients undergoing complex elective cholecystectomy, laparoscopy was associated with more than fourfold higher odds of requiring an unplanned postoperative endoscopic retrograde cholangiopancreatography or interventional radiology procedure compared with robotic surgery. No significant differences in postoperative outcomes were identified between approaches among patients without complex disease.

Robotic procedures cost more in the operating room. For complex cases, average operating room costs were $8,936 with robotics versus $7,720 with laparoscopy—a difference of $1,216. However, after downstream care and complications were included, total costs were nearly identical: $14,476 for robotic surgery and $14,309 for laparoscopy.

The economic advantage did not extend to routine cases. Among patients without complex disease, total costs were about 15% higher with robotics—$11,416 versus $9,925—without an accompanying improvement in postoperative outcomes.

The findings support selective rather than routine use of the technology. As the authors concluded, “strategic application of the robotic platform” may maximize both patient benefit and resource efficiency. Because this was a single-center observational study, results may reflect local expertise and should be confirmed in broader populations.

Source: Caldwell KE, et al. (2026 July 15) JAMA Surg. Outcomes and Costs After Robotic vs Laparoscopic Complex Elective Cholecystectomy