Propensity Score Match Analysis of Laparoscopic versus Robotic-Assisted Cholecystectomy: A 5-Year Retrospective Study

Background While the SAGES Safe Cholecystectomy Program has improved patient safety in laparoscopic cholecystectomies, bile duct injuries continue to occur. Recently, the clinical advantages of robotic-assisted cholecystectomies have come under scrutiny. Within the framework of a comprehensive robotic training program for residents, we aimed to compare the operative outcomes of open, laparoscopic and robotic techniques for cholecystectomy. Methods A retrospective study of 2,345 patients who underwent cholecystectomy at a university-affiliated academic hospital from January 2018 to 2023 was conducted. Data included patient demographics, diagnosis, comorbidities, surgical approach, and complications. Strasberg A-E bile duct injuries, need for salvage procedures, and conversion to open surgery, were compared between laparoscopic, robotic, and open surgery cohorts. Results A total of 2,319 patients were included (784 robotic [RC], 1,535 laparoscopic [LC]). RC cases had higher rates of prior abdominal surgery (35.2% vs 27.8%, p = 0.001), obesity (10.7% vs 8.0%, p = 0.037), and elective operations (65.7% vs 24.9%, p < 0.001), with longer operative times (1.63 vs 1.32 h, p < 0.001). After propensity score matching (n = 1,094), groups were well balanced. BDI occurred in 26 (1.1%) unmatched and 12 (1.1%) matched cases. In the matched cohort, LC was associated with higher BDI risk (OR 5.17, 95% CI 1.12–23.9, p = 0.025), while age also predicted BDI (OR 1.04, 95% CI 1.00–1.08, p = 0.035). Secondary outcomes were largely comparable; RC showed lower rates of post-operative ERCP (2.0% vs 5.3%, p = 0.006), reduced blood loss (10 vs 20 mL, p < 0.001), shorter LOS (1.01 vs 1.14 days, p = 0.043), and fewer conversions to open surgery (0 vs 2.9%, p < 0.001). Conclusion Our results indicate that robotic cholecystectomy remains safe in academic training programs and may offer lower bile duct injury rates and need for salvage procedures or conversion to open surgery, as compared to laparoscopic and open techniques.