Robotic Cholecystectomy Remains Safe and Effective After Regular Hours: a 3 year update

Background Despite growing popularity in robotic assisted surgery, access during evenings and weekends (after-hours) for non-elective operations may be restricted. A prior smaller comparison-study in 2023 found no basis for safety concerns in managing acute cholecystitis in this setting. We seek to publish additional data to help clarify the justification, if any, in restriction of robotic surgery during “after-hours”. Methods We performed a retrospective analysis of 161 patients undergoing robotic cholecystectomy for acute cholecystitis per 2018 Tokyo criteria by a single surgeon at multiple institutions between 2021 and 2026. Patients were grouped as “after-hours” cholecystectomy if the operation started at 17:00 hours or later, or anytime during the weekend (Saturday/Sunday). Demographic, perioperative and outcome variables were tabulated and analyzed. For illustrative purposes, data was presented as median (mean ± standard deviation) were applicable. Results 65 after-hours and 96 regular-hours robotic cholecystectomies were included. There were no significant differences in perioperative variables between the two cohorts in terms of body mass index, age, gender, cirrhotic status, ASA score, white blood cell count, nor neutrophil percentage. With the exception of alkaline phosphatase, there were no significant differences in liver function tests. There were no significant differences in terms of operative time, estimated blood loss, length of stay, complications, nor readmissions. There were no bile duct injuries nor mortalities in either cohort. Conclusion Robotic cholecystectomy can be safely performed on the weekends and evenings. This updated retrospective comparison study should encourage hospitals to support round-the clock robotic surgery access.