Robotic Cholecystectomy Has More Bailouts, Fewer Later Interventions

Yu S, Cheung D, Stucky CC, et al. Bailout Procedures, Downstream Outcomes, and Cost After Robotic vs Laparoscopic Cholecystectomy for Acute Cholecystitis. J Am Coll Surg. September 2026.

Studies comparing robotic and laparoscopic cholecystectomy often exclude bailout procedures. Yu et al. examined how often these procedures occurred and compared subsequent interventions and costs.

The retrospective cohort study used New York and Florida administrative databases from 2012 through 2021. It included 384,617 adults undergoing inpatient, unscheduled cholecystectomy for acute cholecystitis; 4% underwent robotic surgery. Bailout procedures included conversion to open surgery, subtotal cholecystectomy, and cholecystostomy tube placement.

Bailout occurred more frequently with robotic than laparoscopic surgery (1.7% versus 1.4%; adjusted odds ratio, 1.38). Robotic surgery was associated with higher odds of open conversion and subtotal cholecystectomy but lower odds of cholecystostomy tube placement. Bile duct injury rates were similar, at 1.6% in both groups.

Among 5,448 patients requiring bailout, robotic surgery was associated with fewer subsequent endoscopic biliary interventions (3.1% versus 7.7%) and surgical interventions (2.3% versus 7.5%). However, median cumulative costs at 1 year were higher with robotic surgery ($29,702 versus $24,483).

The authors concluded that robotic cholecystectomy was associated with slightly more bailouts and fewer subsequent interventions among patients who required a bailout. Costs remained higher with robotic surgery. This observational study cannot establish that the surgical approach caused these differences.