Robotic Cholecystectomy Remains Safe and Effective After Regular Hours: A 3-Year Update.

Background and Objectives: Despite growing popularity in robotic-assisted surgery, access during evenings and weekends for nonelective operations may be restricted. A prior smaller comparison study in 2024 found no basis for safety concerns in managing acute cholecystitis in this setting. We sought to provide additional data to further evaluate whether restriction of robotic cholecystectomy during "after-hours" is justified. Methods: We performed a retrospective analysis of 161 patients undergoing robotic cholecystectomy for acute cholecystitis according to 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 5 pm or later, or anytime during the weekend (Saturday/Sunday). Preoperative, intraoperative, and outcome variables were tabulated and analyzed. Results: Sixty-five after-hours and 96 regular-hours robotic cholecystectomies were included. There were no significant differences in perioperative variables between the 2 cohorts in terms of body mass index, age, sex, 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 operative time, estimated blood loss, length of stay, complications, nor 30-day readmissions. No bile duct injuries or mortalities occurred in either cohort. Conclusion: In this 5-year retrospective comparison, robotic cholecystectomy performed during evenings and weekends was associated with similar perioperative outcomes compared with regular-hours cases within a single experienced surgeon's practice. These findings support the feasibility of after-hours robotic cholecystectomy in this setting and provide a basis for further multisurgeon investigation.