Observational studySurgical endoscopy2025
Robotic versus laparoscopic cholecystectomy for difficult gallbladders: an observational study of tertiary centre cases.
Observational study in Surgical endoscopy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.
What it found
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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.
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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.
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Who cites it
4 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Clinical outcomes of laparoscopic versus robotic cholecystectomy approaches: a systematic review and GRADE assessment meta-analysis.Journal of robotic surgery · 2025Pooled it
- Robotic Cholecystectomy: Outcomes, Safety, and Value in the Era of Advanced Technology.Journal of surgery and research · 2026Article
- Robotic versus laparoscopic surgery in hepatobiliary procedures: a scoping review.BMC surgery · 2026Article
- The final cut: a multi-centre cohort study evaluating outcomes of robotic completion cholecystectomy.Surgical endoscopy · 2025Article
Corrections and comments
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAlthough laparoscopic cholecystectomy (LC) is considered a low-risk procedure, intraoperative bleeding, bile duct injury and bile leak occur frequently in the 'difficult' gallbladder. Robotic cholecystectomy (RC) can overcome difficulties related to poor vision and instrumentation in difficult cases to avoid intraoperative complications and conversion to open surgery. The aim of the study was to evaluate the outcomes of laparoscopic and robotic cholecystectomy in patients with difficult gallbladders referred to a tertiary HPB centre.
methodsWe conducted a retrospective review of all patients referred to a senior hepatobiliary and pancreatic surgeon with a 'difficult' gallbladder between December 2013 and March 2024. Primary outcomes were conversion to open procedure, and 30-day post-operative complications.
resultsA total of 88 difficult gallbladder cases (n = 35 laparoscopic, n = 53 robotic) were referred to a tertiary HPB centre during the study period, consisting of 21.7% of cholecystectomies (n = 404). The total complication rate (14.3% vs 3.8%, OR 4.25, 95% CI 0.77-23.28, p = 0.0951) and conversion rate (8.6% vs 0.0%, OR 11.52, 95% CI 0.57-230.32, p = 0.109) were both higher in the laparoscopic group, but these differences were not statistically significant. The median operative time was significantly higher in the laparoscopic group (108.5 min vs 50.0 min, p = 0.001).
conclusionsBoth robotic and laparoscopic cholecystectomy are viable approaches in difficult gallbladder cases, with robotic cholecystectomy being associated with potentially fewer complications and conversions to open surgery. Pre-operative referral of patients with difficult gallbladders and the intra-operative abandonment of difficult cases can both be considered safe exit strategies for difficult gallbladder cases.
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