Robotic Cholecystectomy May Reduce Adverse Outcomes in High-Risk Patients with high BMI: JAMA

A new study published in the Journal of American Medical Association showed that robotic cholecystectomy (RC) resulted in fewer negative consequences compared to laparoscopic cholecystectomy (LC) in specific patients, particularly showing significant advantages in high-risk situations and individuals with increased BMI.

Recent studies have highlighted worries about the safety and expenses associated with RC in comparison to LC. These studies were restricted by differences in surgeon expertise and insufficient consideration of the complexity of the procedures. Hence, this research evaluated the clinical results and costs of RC and LC within a large health system involving surgeons who regularly conduct both surgeries. Additionally, the aim was to create a tool for assessing risks before surgery.

A retrospective study conducted at eight hospitals from 2020 to 2021 examined minimally invasive cholecystectomy procedures. The study included adults who underwent LC or RC, excluding those with planned open procedures, malignancies, or concomitant procedures. Surgical complexity was categorized as low/intermediate risk (≤6) or high risk (≥7) based on the Nassar preoperative score.

Over a 90-day follow-up period, adverse events were monitored, defined as conversion or complications of Clavien-Dindo grade ≥3, along with the total cost of care. Predictors of adverse outcomes were identified using multivariable models, and average treatment effects on costs were estimated using inverse probability weighting. A risk calculator was developed to predict the likelihood of adverse outcomes based on the surgical method used.

Out of 1828 patients, 806 (44.1%) had RC and 1022 (55.9%) underwent LC. RC resulted in reduced hospital stays and fewer negative outcomes when compared to LC (3.3% vs 8.7%; *P*<.001). The type of surgery had a significant impact based on Nassar risk and BMI.

LC had a higher risk of adverse outcomes for high-risk patients with a BMI of 30 and low/medium-risk patients with a BMI of 35. However, RC incurred higher variable expenses in both risk categories. The risk prediction tool showed good accuracy, with AUCs of 0.744 in the training group and 0.750 in the validation group.

Overall, this research found that RC resulted in fewer negative consequences for specific patients when compared to LC. The most significant advantage was seen in high-risk cholecystectomy cases and patients with a high BMI. Nonetheless, RC was linked to greater expenses regardless of the risk level.

Source:

Chopra, A., El Asmar, R., Hodges, J. C., Tirukkovalur, N., Bizri, N., Neal, M., Metcalf, M., Lee, K., Paniccia, A., & Zureikat, A. H. (2026). Comparative analysis of robotic and laparoscopic cholecystectomy. JAMA Surgery. https://doi.org/10.1001/jamasurg.2026.4128