Introduction

Robot-assisted cholecystectomy (RC) and laparoscopic cholecystectomy (LC) are the most

common surgical approaches to treat acute cholecystitis. The 2018 Tokyo Guidelines is a widely

used grading system for acute cholecystitis. This study aims to compare the utilization of RC

and LC across Tokyo Guidelines severity grades and to establish a foundation for further

analysis of associated operative and economic outcomes.

Methods

This retrospective study analyzed 171 cholecystectomy cases, 95 RC and 76 LC from Kings

County Hospital between December 2019 to October 2022. Patients with traumatic abdominal

injuries or Whipple procedures were excluded from the study. Cholecystitis severity was then

graded using the Tokyo Guidelines. Demographic and clinical characteristics were comparable

between groups.

Results

Of the 76 LC cases, 24 were classified as Grade 1, 50 as Grade 2, and 2 as Grade 3 according

to the Tokyo Guidelines. Among the 95 robotic-assisted cholecystectomy (RC) cases, 45 were

Grade 1, 43 were Grade 2, and 7 were Grade 3. Fisher’s exact tests were performed on raw

case counts to compare the distribution of surgical approaches within each severity grade. A

statistically significant difference in surgical approach was observed for both Grade 1 (p =

0.042) and Grade 2 (p = 0.009). No statistically significant difference was found for Grade 3

cases (p = 0.302).

Conclusion

The use of robot-assisted cholecystectomy in Grade 1 and Grade 2 cholecystitis was

statistically significant when compared to laparoscopic cholecystectomy. No significant

difference was observed in surgical approach for Grade 3 cases even though RC was more

commonly utilized in this severity grade. RC was associated with no reported complications,

while three complications occurred in LC cases: gallbladder fossa hematoma, surgical site

infection, and intraoperative liver laceration. Ongoing analysis will evaluate operative time,

hospital length of stay, and cost differences between RC and LC.