Evidence map›Paper›PMID 41238991›Full record

ArticleSurgical endoscopy2026

Robotic versus pure laparoscopic approach to subtotal fenestrating cholecystectomy: does the robot improve postoperative outcomes?

Katharine E Caldwell, Edie Threlkeld, Joseph Litrel, Ryan C Fields, Roheena Z Panni, Trang Nguyen, Natasha Leigh, Dominic E Sanford

Abstract readComparative Study
PubMed Publisher
In one paragraph

Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Katharine E CaldwellDepartment of Surgery, Section of Hepatobiliary, Pancreatic, and Gastrointestinal Surgery, Washington University in Saint Louis, Saint Louis, MO, USA. kecaldwell@wustl.edu.ORCID 0000-0002-4330-9521
Edie ThrelkeldDepartment of Surgery, Section of Hepatobiliary, Pancreatic, and Gastrointestinal Surgery, Washington University in Saint Louis, Saint Louis, MO, USA.
Joseph LitrelDepartment of Surgery, Section of Hepatobiliary, Pancreatic, and Gastrointestinal Surgery, Washington University in Saint Louis, Saint Louis, MO, USA.
Ryan C FieldsDepartment of Surgery, University of Rochester, Rochester, NY, USA.
Roheena Z PanniDepartment of Surgery, Section of Hepatobiliary, Pancreatic, and Gastrointestinal Surgery, Washington University in Saint Louis, Saint Louis, MO, USA.
Trang NguyenDepartment of Surgery, Section of Hepatobiliary, Pancreatic, and Gastrointestinal Surgery, Washington University in Saint Louis, Saint Louis, MO, USA.
Natasha LeighDepartment of Surgery, Section of Hepatobiliary, Pancreatic, and Gastrointestinal Surgery, Washington University in Saint Louis, Saint Louis, MO, USA.
Dominic E SanfordDepartment of Surgery, Section of Hepatobiliary, Pancreatic, and Gastrointestinal Surgery, Washington University in Saint Louis, Saint Louis, MO, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundRobotic cholecystectomy represents an increasing proportion of all cholecystectomies. Subtotal fenestrating cholecystectomy (SFC) is a well-described bailout procedure for the difficult cholecystectomy. No prior work has compared traditional laparoscopic SFC to robotic SFC. STUDY

designWe performed a single-center retrospective cohort study of adults who underwent robotic or laparoscopic SFC between 2018 and 2024 at a tertiary academic medical center. The primary outcome was composite post-operative biliary events requiring intervention by ERCP. Cost analysis was performed by examining operative cost and total care cost for additional readmission or intervention within 90-day post-operative period. Secondary outcomes were compared using Fisher's Exact Testing, Mann-Whitney, or independent t-testing as appropriate.

resultsWe reviewed 1851 patients undergoing cholecystectomy, 126 required SFC (6.8%), 96 laparoscopic SFC and 30 robotic SFC. There was no difference in demographics or comorbidity between groups. Unplanned post-operative ERCP was required in 30 patients with a significantly higher rate in laparoscopic SFC (29.2% v 6.7%, p = 0.01). Robotic SFC was noted to have lower overall complication rates (16.6% v 42.7%, p 0.02), estimated blood loss (33.7.cc v. 62.5cc, p = 0.01) and a decrease in the number of days patients required a surgical drain (2.4 v 9.6, p = 0.02). Additionally, robotic SFC had a significantly lower rate of conversion to open (3.3% v 17.7%, p = 0.05). While laparoscopic SFC had lower operative cost ($8119 v $9367, p 0.03), the there was no difference in total cost of care between robotic and laparoscopic groups ($18,695 v $17,270, p 0.71).

conclusionRobotic SFC offers several benefits compared to pure laparoscopic SFC, including decreased biliary leak with lower rates of unplanned ERCP, lower need for conversion to open, and lower overall complication rates. While laparoscopic SFC has lower operative cost, the increased complication and readmission rate results in no difference in overall cost of care.

Indexed as

CholecystectomyCholecystectomy, LaparoscopicPostoperative ComplicationsRobotic Surgical ProceduresAdultAgedCholangiopancreatography, Endoscopic RetrogradeFemaleHumansMaleMiddle AgedPatient ReadmissionRetrospective StudiesTreatment OutcomeCholecystectomyMinimally invasive surgeryRobotic surgerySubtotal cholecystectomy

Identifiers

PMID41238991

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.