Acute cholecystitis in the robotic era: comparative safety and feasibility of robotic and laparoscopic cholecystectomy in an acute care surgery service.

This study aimed to evaluate and compare perioperative outcomes of robotic versus laparoscopic cholecystectomy in patients with acute cholecystitis within an Acute Care Surgery setting. A retrospective cohort study was conducted including patients who underwent cholecystectomy for acute cholecystitis between January 1, 2023, and March 1, 2026. Patients were stratified by operative approach (robotic vs. laparoscopic). Baseline demographics, comorbidities, and postoperative outcomes were analyzed. Continuous variables were compared using Mann-Whitney U test, and categorical variables were assessed with Pearson χ². Statistical significance was defined as p < 0.05. A total of 322 patients were included, with 107 undergoing robotic and 215 laparoscopic cholecystectomies. Baseline characteristics were similar between groups. Median operative time did not differ significantly (78.0 [63.0-107.0] minutes robotic vs. 77.0 [60.0-95.0] minutes laparoscopic, p = 0.31). Conversion to open surgery occurred in one laparoscopic case (0.5%) and none in the robotic group. Length of hospital stay was comparable. Early postoperative complications were similar (10.3% robotic vs. 12.6% laparoscopic, p = 0.97), including comparable rates of severe (Clavien-Dindo III-IV) complications. Readmission and reintervention rates did not differ significantly. Two postoperative bile leaks occurred, one in each group. Subgroup analysis of gangrenous cholecystitis showed no significant differences in operative time, length of stay, or postoperative outcomes. Robotic cholecystectomy demonstrates comparable safety and efficacy to laparoscopic cholecystectomy for acute cholecystitis, including in severe cases, supporting its feasibility in acute care settings.