Risk of Bile Duct Injury Is Significantly Higher in Robotic Cholecystectomy versus Laparoscopic

Mullens CL, Sheskey S, Thumma JR, et al. Patient Complexity and Bile Duct Injury after Robotic-Assisted vs Laparoscopic Cholecystectomy. JAMA Netw Open. 2025;8(3):e251705.

Urbach DR. Robotic-Assisted Cholecystectomy—for Whom? JAMA Netw Open. 2025;8(3):e251711.

Available evidence has suggested that rates of bile duct injury are higher for robotic cholecystectomy compared with laparoscopic cholecystectomy. This study assessed rates of bile duct injuries for Medicare patients (n = 737,908) who underwent laparoscopic or robotic cholecystectomy during the interval 2010–2021.

Rates of bile duct injuries requiring operative intervention were the outcomes of interest. Patients were categorized according to patient and hospital factors into low, medium, and high-risk groups.

Bile duct injury was significantly higher for robotic procedures, and this difference was observed consistently in all risk groups. Other outcomes such as rates of complications and readmission were similar in the two groups. Reoperations occurred more often in the robotic group.

The authors concluded that patient complexity and risk for bile duct injury did not contribute to the differences in rates of this complication.

In the editorial that accompanied the article, Urbach emphasized the need for surgeons to recommend laparoscopic or robotic cholecystectomy based on relative risks and benefits as well as patient goals and preferences.