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. 2025 Aug 28.
doi: 10.1007/s00464-025-12044-1. Online ahead of print.

The final cut: a multi-centre cohort study evaluating outcomes of robotic completion cholecystectomy

Irena Stefanova #  1   2 , Rosie Callahan #  3 , Vandana B Giriradder  4 , Nabeel Merali  5 , Lydia Renardson  4 , Shi Lam  6 , Siong-Seng Liau  6 , Esther Platt  5 , Angela Riga  5 , Rajesh Kumar  5 , Tim R Worthington  5 , Adam E Frampton  5   7 , Rajiv P Lahiri  5 , Tim D Pencavel  5 , Jawad Ahmad  4
Affiliations

The final cut: a multi-centre cohort study evaluating outcomes of robotic completion cholecystectomy

Irena Stefanova et al. Surg Endosc. .

Abstract

Background: Subtotal and abandoned cholecystectomies are on the rise due to the increase of laparoscopic cholecystectomies performed in the emergency setting. Persistent biliary symptoms postoperatively may necessitate a completion cholecystectomy (CC) which is a technically challenging procedure. The literature describing outcomes of minimally invasive CC is scarce and consisting of small studies only. This retrospective multi-centre study aimed to assess the safety and effectiveness of the robotic approach to CC.

Methods: All consecutive patients (> 18 years), undergoing a robotic CC between August 2020 and March 2025, were included. Primary outcome was success of robotic procedure. Secondary outcomes were open conversion, subtotal and abandoned cholecystectomy rate, postoperative complications, length of hospital stay, 30-day re-admission and 90-day mortality. A P value < 0.05 was considered significant. Data were analysed using IBM SPSS Statistics Version 29.0.1.0 (171).

Results: A total of 44 adult patients with a median age was 58.5 years (IQR: 43.5 - 73.3) undergoing robotic CC were included. Previous subtotal cholecystectomy was performed in 72.7% (32/44) of referrals, whereas abandoned cholecystectomy was recorded in 27.3% (12/44). There were no abandoned robotic CCs. Subtotal cholecystectomy was required in two cases (4.5%, 2/44), and conversion to open procedure was reported in one case 2.3% (1/44). A successful robotic CC was documented in 93.2% (41/44) of procedures. Overall morbidity rate was 6.8% (3/44) with a Clavien-Dindo grade ≥ 3 in 2.3% (1/44) of cases. All complications were observed in the previous subtotal cholecystectomy group (9.4%, 3/32) vs the abandoned cholecystectomy group (0%, 0/12), however, this difference was not significant (P = 0.55, 95% CI [-0.065, 0.25]).

Conclusion: Robotic CC is a safe and technically feasible approach with high success and low complication rates. This study, the largest of its kind, supports the expanding role of robotic platforms in managing difficult gallbladder pathology in the re-operative setting.

Keywords: Abandoned cholecystectomy; Completion cholecystectomy; Remnant gallbladder; Robotic surgery; Subtotal cholecystectomy.

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Conflict of interest statement

Declarations. Disclosure: Irena Stefanova, Rosie Callahan, Vandana B. Giriradder, Nabeel Merali, Lydia Renardson, Shi Lam, Siong-Seng Liau, Esther Platt, Angela Riga, Rajesh Kumar, Tim R. Worthington, Adam E. Frampton, Rajiv P. Lahiri, Tim D. Pencavel and Jawad Ahmad have no conflict of interest or financial ties to disclose.

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