# Robotic Versus Laparoscopic Cholecystectomy in Complex Acute Cholecystitis: A Comparative Analysis of Postoperative Recovery

## TL;DR

Robotic cholecystectomy leads to faster recovery and fewer complications than laparoscopic cholecystectomy in complex acute cholecystitis cases.

## Contribution

This study provides real-world comparative data on robotic versus laparoscopic cholecystectomy outcomes in complex acute cholecystitis.

## Key findings

- Robotic cholecystectomy was associated with shorter ICU and hospital stays compared to laparoscopic cholecystectomy.
- Patients undergoing robotic cholecystectomy reported lower postoperative pain scores and faster return to daily activities.
- Robotic cholecystectomy had no conversions to open surgery, unlike laparoscopic cholecystectomy.

## Abstract

Background

Robotic cholecystectomy (RC) has emerged as an alternative to laparoscopic cholecystectomy (LC) in the management of complex acute cholecystitis (AC); however, real-world comparative data on perioperative outcomes and postoperative recovery remain limited. This study aimed to compare short-term perioperative outcomes and recovery parameters following RC and LC for complex AC in routine clinical practice.

Materials and methods

This was a retrospective observational study conducted using prospectively maintained clinical records. Consecutive adult patients diagnosed with complex AC, defined as Grade II or Grade III disease according to the Tokyo Guidelines, who underwent RC or LC between February 2024 and July 2025 were included. All procedures were performed by a single surgeon experienced in both techniques, thereby minimizing operator-related variability.

Results

In total, 142 patients undergoing cholecystectomy were evaluated, of whom 91 underwent an RC and 51 underwent an LC. Baseline clinical profiles were largely balanced between the two cohorts. However, the RC group included a greater proportion of male patients and demonstrated a higher distribution of American Society of Anesthesiologists (ASA) physical status classifications. Conversion to open surgery occurred more frequently in the LC group, whereas no conversions were recorded in the RC group (p<0.001). The mean total port count differed significantly between the groups, with a higher number observed in the RC cohort. Patients in the RC group demonstrated significantly shorter ICU and total hospital stays, as well as earlier resumption of oral intake and independent ambulation (all p-values <0.001). Time to first postoperative bowel movement also occurred earlier in the robotic group, although this difference did not reach statistical significance (p=0.0668). Postoperative pain scores were significantly lower in the RC cohort at 24 hours and at seven, 14, and 30 days following surgery (all p-values <0.001, except day 30; p=0.0042). Patients treated with RC achieved a faster return to routine daily activities, with a statistically significant between-group difference (p<0.001). Intraoperative complication rates were comparable between the groups, and no postoperative complications, 30-day readmissions, or deaths occurred in either cohort.

Conclusion

RC was associated with improved perioperative outcomes and faster postoperative recovery compared with LC in complex AC, without increased short-term morbidity or mortality. Prospective multicenter studies with standardized outcome assessment are required to validate these findings.