Appendectomies are one of the most common procedures performed each year. A study analyzing the National Hospital Discharge Survey data for the years 1979–1984 found that an estimated 250,000 appendicitis cases occurred annually.1 During this period, the approximated lifetime risk of undergoing an appendectomy was 12.0% for men and 23.1% for women.
The surgical approach has changed significantly over the past century. In 1893, Charles McBurney, MD, introduced the gridiron (McBurneys) incision for open appendectomies, which remained the standard approach for more than a century. Kurt Semm, MD, performed the first laparoscopic appendectomy in 1981, but it wasn’t until 2017, when 95% of appendectomies were performed using this technique, that it became widely recognized as the standard approach.2
Interestingly, while it took many years to develop the laparoscopic technique that ultimately overtook the open appendectomy, robotic-assisted technology was being used before laparoscopic appendectomies became standard. In fact, the first robotic appendectomy was performed incidentally during an elective gynecologic surgery in 2008, with the first robotic-assisted appendectomy for acute appendicitis completed in New Jersey in 2013.3
Today, laparoscopic appendectomy remains the preferred approach due to strong evidence demonstrating cost-effectiveness, shorter hospital stays, and improved patient outcomes when compared to open approaches.
Nevertheless, the potential advantages of robotic-assisted laparoscopic appendectomy should not be overlooked simply because of a paucity of studies for a newer approach. As robotic surgery continues to grow in emergency general surgery and more residency programs incorporate robotic training, further research will help clarify its role alongside established techniques.
Comparing Patient Outcomes
Given the fact that laparoscopic appendectomy is a very common procedure, often completed with easily accessible equipment, a common concern for many surgeons is that robotic-assisted appendectomy may not offer a significant difference in outcomes but would potentially use limited robotic availability or potentially add unnecessary costs to the patient. While there are ongoing prospective research studies that examine this supposition, we will review two retrospective studies in this article.
In a single-center study comparing laparoscopic and robotic-assisted appendectomies performed over 2 years by two experienced surgeons with equal proficiency in both techniques, researchers assessed outcomes data that included operative duration, length of hospital stay, conversion to open surgery, and 30-day readmission rates.3 There was no significant difference in operative time between the two approaches.
However, robotic-assisted appendectomies were associated with significantly shorter hospital stays. Conversion to open surgery occurred in 0.91% of laparoscopic cases, while no robotic cases required conversion. Readmission rates were comparable between both groups.
A second study using the ACS National Surgical Quality Improvement Program database from 2016 to 2021 analyzed 49,850 patients who underwent minimally invasive appendectomy.4 Of these, 49,800 underwent laparoscopic and only 50 underwent robotic-assisted appendectomy, highlighting the rarity of robotic use during this period. The limited adoption of robotic appendectomy may be attributed to the longstanding efficacy and optimization of traditional laparoscopic techniques, which have reduced the perceived need for newer approaches.
The study authors found that robotic-assisted appendectomies were associated with longer operative times, but reduced hospital stays by 14.4 hours, with no difference in readmission rates. Notably, robotic cases showed a higher 30-day mortality rate, which may be influenced by variability in surgeon proficiency. While robotic procedures may appear costlier due to longer operating room time, the reduced length of stay could offset these costs, suggesting potential overall economic balance if performed by experienced surgeons.
Both studies described here demonstrate that robotic-assisted appendectomies are associated with shorter hospital stays and comparable readmission rates. However, a key distinction involves the impact of surgical skill due to the fact that outcomes in robotic cases are closely tied to the surgeon’s proficiency. The true value of robotic surgery in appendectomies cannot be accurately assessed without experienced, well-trained surgeons performing the procedures.
Just as open appendectomy was once the standard before laparoscopic techniques became widely accepted and refined, robotic-assisted surgery has the potential to emerge as the next advancement. This reality underscores the need to train a new generation of surgeons with early and consistent exposure to robotic techniques during residency, which will help ensure continued progress in surgical care.
Integration of Robotics Training in General Surgery Curricula
Developing a robust robotic surgery training experience for residents presents many challenges, particularly due to high costs, limited availability of equipment, and faculty comfort levels.
Current training often incorporates many of the same steps recommended by robotics companies for faculty training, such as online modules, dry and wet lab simulations, bedside assistance, and supervised console time. While dual-console systems offer advantages, such as allowing faculty to guide residents during procedures, their implementation requires significant investment, limiting widespread adoption and slowing formal curriculum development. As a result, many general surgery programs lack a standardized robotics curriculum.
A survey distributed to members of the Southwestern Surgical Congress received 28 responses, with 89% of programs reporting some form of robotics training; however, only approximately 53% of residents completed the full training, highlighting a lack of emphasis on comprehensive robotic education.5
This training shortage is further reflected in current certification standards. While the American Board of Surgery requires completion of the Fundamentals of Laparoscopic Surgery to qualify for board certification, and the Accreditation Council for Graduate Medical Education (ACGME) mandates a minimum of 175 laparoscopic cases during residency, there currently are no equivalent requirements for robotic-assisted surgery.
A separate survey sent to ACGME-accredited general surgery program directors yielded 20 responses from a mix of academic, hybrid, and community programs, primarily with medium-sized residency classes.6 Among these, 74% reported having a formal robotic surgery curriculum. However, program directors perceived a lower institutional interest in incorporating such training, which may contribute to limited efforts toward curriculum improvement. Common barriers to developing a structured robotic surgery training program included limited funding, faculty availability, simulation access, and protected training time.6
Ultimately, the evolution of appendectomy techniques, from open to laparoscopic to robotic, reflects ongoing surgical innovation tempered by practical constraints such as cost, training, and experience. While robotic-assisted appendectomy may offer advantages for some patients, its broader adoption into practice depends not only on further research to establish its comparative benefits but also on the development of structured, accessible training pathways.
Future Directions
The need for systematic education is especially important given the shifting context in which robotic-assisted surgery is now being taught. Upon their debut, robotic surgery techniques were primarily adopted by fully trained surgeons with a strong foundation in core surgical principles, enabling robotics to be incorporated as an advanced extension of their existing skillsets. In contrast, today’s residents are exposed to robotic technology much earlier, often while still learning fundamental surgical techniques, creating a dual learning curve. At the same time, attending surgeons are adapting to a new role as robotics educators, often without having received formal training in how to teach this evolving modality. Together, these dynamics underscore the importance of thoughtful curriculum design and mentorship models to support the next generation of robotic surgeons.
