# The final cut: a multi-centre cohort study evaluating outcomes of robotic completion cholecystectomy

## TL;DR

This study shows that robotic completion cholecystectomy is a safe and effective option for patients needing further surgery after incomplete or abandoned gallbladder removal.

## Contribution

The study is the largest to date evaluating robotic completion cholecystectomy outcomes across multiple centers.

## Key findings

- Robotic completion cholecystectomy had a 93.2% success rate with low complication rates.
- No robotic procedures were abandoned, and only one case required conversion to open surgery.
- Complications were observed only in patients with prior subtotal cholecystectomy, but the difference was not statistically significant.

## Abstract

Subtotal and abandoned cholecystectomies are on the rise due to the increase of laparoscopic cholecystectomies performed in the emergency setting. Persistent biliary symptoms postoperatively may necessitate a completion cholecystectomy (CC) which is a technically challenging procedure. The literature describing outcomes of minimally invasive CC is scarce and consisting of small studies only. This retrospective multi-centre study aimed to assess the safety and effectiveness of the robotic approach to CC.

All consecutive patients (> 18 years), undergoing a robotic CC between August 2020 and March 2025, were included. Primary outcome was success of robotic procedure. Secondary outcomes were open conversion, subtotal and abandoned cholecystectomy rate, postoperative complications, length of hospital stay, 30-day re-admission and 90-day mortality. A P value < 0.05 was considered significant. Data were analysed using IBM SPSS Statistics Version 29.0.1.0 (171).

A total of 44 adult patients with a median age was 58.5 years (IQR: 43.5 – 73.3) undergoing robotic CC were included. Previous subtotal cholecystectomy was performed in 72.7% (32/44) of referrals, whereas abandoned cholecystectomy was recorded in 27.3% (12/44).

There were no abandoned robotic CCs. Subtotal cholecystectomy was required in two cases (4.5%, 2/44), and conversion to open procedure was reported in one case 2.3% (1/44). A successful robotic CC was documented in 93.2% (41/44) of procedures. Overall morbidity rate was 6.8% (3/44) with a Clavien-Dindo grade ≥ 3 in 2.3% (1/44) of cases. All complications were observed in the previous subtotal cholecystectomy group (9.4%, 3/32) vs the abandoned cholecystectomy group (0%, 0/12), however, this difference was not significant (P = 0.55, 95% CI [-0.065, 0.25]).

Robotic CC is a safe and technically feasible approach with high success and low complication rates. This study, the largest of its kind, supports the expanding role of robotic platforms in managing difficult gallbladder pathology in the re-operative setting.