Introduction: Acute appendicitis is a leading surgical emergency, with laparoscopic appendectomy as the standard of care. Robotic appendectomy has emerged as an alternative approach; however, comparative evidence remains limited. We conducted a multicenter national database analysis comparing robotic and laparoscopic appendectomy.

Methods: Data obtained from ACS-NSQIP database from January 1, 2022, to December 31, 2023. Patients ≥18 years undergoing laparoscopic appendectomy were identified using CPT code 44970 with the ACS-NSQIP variable for robotic assistance. Cases were stratified into robotic and laparoscopic cohorts. Primary outcomes included conversion to open surgery, SSI, and operative time. Secondary outcomes were length of stay and mortality. 30-day postoperative events were assessed. 1:1 Propensity score matching was conducted to control for baseline differences.

Results: Among 95,824 patients who met inclusion criteria, 1.3% underwent robotic and 98.7% laparoscopic appendectomy. After 1:1 propensity score matching, 1,212 matched pairs (N=2,424) were analyzed. Baseline characteristics included a median age of 47 years, 49% male, and 31% with ASA ≥ III; no significant differences were observed between groups. Organ/space SSI occurred in 1.9% of robotic cases compared with 3.9% of laparoscopic cases. Superficial SSI (0.5% vs. 0.5%) and deep incisional SSI (0.2% vs. 0.1%) were infrequent and comparable between groups. Operative time was longer in the robotic cohort (median 64.5 vs. 47 minutes). Conversion to open surgery, length of stay, readmissions, and mortality were similar between the two approaches.

Discussion: Robotic appendectomy demonstrated a lower rate of organ/space SSI compared with laparoscopy (1.9% vs. 3.9%), suggesting that enhanced visualization and instrument precision may reduce infectious complications. Operative time was longer in the robotic cohort (median 64.5 vs. 47 minutes), consistent with known setup time and learning curve associated with robotic surgery. Conversion to open surgery, length of stay, readmissions, and mortality were comparable between groups, supporting the perioperative safety of the robotic approach. These population-level findings from over 2,400 propensity score-matched patients corroborate prior single-center studies and strengthen the evidence base for robotic appendectomy.

Conclusions: Robotic appendectomy is a safe and feasible alternative to laparoscopic appendectomy, with lower organ/space SSI rates but longer operative times. The extended operative duration and potential cost implications warrant further investigation before broader adoption in emergency surgical settings.