{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T02:41:20Z","timestamp":1792291280359,"version":"4.4.0"},"reference-count":21,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"\n Importance<\/jats:title>\n As the use of robotic cholecystectomy increases, its value remains poorly defined for complex elective cholecystectomy (CEC), where complex gallbladder pathology results in increased technical difficulty.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine whether a robotic approach is associated with improved clinical outcomes and altered total hospital cost as compared with a laparoscopic approach for patients undergoing CEC.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cohort study analyzed data from an academic hepatobiliary referral center for patients who underwent cholecystectomy from August 2018 to August 2024. CEC was defined by preoperative criteria: prior aborted or partial cholecystectomy, presence of a cholecystostomy tube, and\/or history of gallbladder perforation or fistula.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Robotic-assisted vs laparoscopic cholecystectomy.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was a composite of an unplanned postoperative endoscopic retrograde cholangiopancreatography or interventional radiology procedure. Secondary outcomes included operative time, postoperative complications, and operative and total hospital costs.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 863 patients underwent cholecystectomy and met inclusion criteria; 525 (60.8%) were female and 338 (39.2%) were male, and their median (IQR) age was 61 (45-71) years. Among patients undergoing CEC, the laparoscopic approach was independently associated with an increased need for unplanned endoscopic or percutaneous intervention compared with the robotic group (odds ratio, 4.24; 95% CI, 1.24-14.52;\n P<\/jats:italic>\n \u2009=\u2009.02). There were no significant differences in postoperative outcomes between the laparoscopic and robotic groups in patients undergoing non-CEC. Patients undergoing the laparoscopic approach had significantly reduced operating room costs when compared with patients undergoing a robotic approach in both the CEC ($7720 vs $8936, respectively) and non-CEC groups ($6368 vs $ 8351, respectively). However, there was no difference in the overall total cost of care between laparoscopic CEC and robotic CEC groups ($14\u202f309 vs $14\u202f476, respectively). The overall total cost of care was significantly higher for patients undergoing robotic non-CEC as compared with laparoscopic non-CEC ($11\u202f416 vs $9925, respectively).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This study found that for complex gallbladder disease, robotic cholecystectomy offers a clinical advantage, reducing complications and downstream interventions without increasing the overall costs of care. These findings suggest strategic application of the robotic platform may offer clinical advantages in high-complexity gallbladder surgery, maximizing patient benefit and resource efficiency.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamasurg.2026.2650","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T15:00:23Z","timestamp":1784127623000},"page":"909","source":"Crossref","is-referenced-by-count":4,"title":["Outcomes and Costs After Robotic vs Laparoscopic Complex Elective Cholecystectomy"],"prefix":"10.1001","volume":"161","author":[{"given":"Katharine E.","family":"Caldwell","sequence":"first","affiliation":[{"name":"Medical University of South Carolina, Section of Surgical Oncology, Charleston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edie","family":"Threlkeld","sequence":"additional","affiliation":[{"name":"Washington University in St Louis, Department of Surgery, Section of Hepatobiliary, Pancreatic, and Gastrointestinal 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