Robotic Cholecystectomy is Safe and Effective for all Levels of Gallbladder Pathology in both the Elective and Emergent Setting in a Patient Population with a High Comorbidity Load: Outcomes from East Flatbush, New York Submission to the Journal of Robotic Surgery

Background The value of using the Da Vinci robotic platform to perform a cholecystectomy is still under investigation, particularly within emergent settings. The aim of our study is to analyze the safety, efficacy, and clinical outcomes associated with robotic cholecystectomy among patients with a high comorbidity load, comparative health disparities, and varying degrees of gallbladder pathology. Objective To measure and compare 30-day postoperative complications seen in the robot-assisted cholecystectomy in a patient population with a high comorbidity load. Methods We conducted a single-institution, retrospective analysis of a total of 218 patients who underwent either an elective or emergent robotic cholecystectomy from January 2019 to January 2024. All cases were performed at a tertiary care hospital by four surgeons with varying levels of robotic experience, ranging from 25 years to 7 years of robotic experience. Baseline preoperative demographics, comorbidities, severity of gallbladder pathology, and 30-day clinical outcomes were recorded. Results Of the 218 patients, 94 were emergent and 124 were elective. All had varying degrees of gallbladder pathology. The emergent cases were significantly more likely to have severe pathological findings compared to the elective cases. The overall complication rate in our population was 7.3%. The most common complications were postoperative sickle cell crisis, hepatic abscess, and incisional seroma. No bile duct injuries were encountered, and minimal 30-day outcomes were encountered. Conclusions In both elective and emergent settings, robotic cholecystectomy is safe and effective in a patient population with a high comorbidity load, health disparities, and varying degrees of gallbladder pathology.