Outcomes following adoption and integration of robotic-assisted cholecystectomy for pediatric biliary tract disease: An eight-year, single-center experience

INTRODUCTION: The incidence of pediatric gallstone disease continues to rise, largely driven by increasing obesity rates. Laparoscopic cholecystectomy (LC) has been the standard surgical approach, with robotic-assisted cholecystectomy (RAC) utilized less frequently. This study aimed to evaluate the implementation of RAC and its outcomes compared to LC at a single institution. METHODS: A retrospective cohort study was conducted of all pediatric cholecystectomies at our children's hospital from 2017 through 2024. Surgical outcomes were abstracted. Statistical tests were employed, with p < 0.05 considered significant. RESULTS: , and 75 % of patients were female. The most common diagnoses were choledocholithiasis (179) and symptomatic cholelithiasis (135). Yearly cholecystectomies increased. LC was performed more often for urgent cases (p < 0.01). RAC was used more often in patients with obesity and severe obesity (p = 0.01). Median operative time slightly differed between LC and RAC (11 min; p < 0.01). There was one conversion to open (LC) and nine retained common duct stones. There was no difference in emergency department revisits (7.7 % LC vs 6.7 % RAC; p = 0.69) or readmissions (2.6 % LC vs 3.1 % RAC; p = 0.73). There were no bile leaks, common bile duct injuries or mortalities. CONCLUSION: In this largest reported cohort of pediatric RAC, RAC was found to be safe and effective compared with LC, particularly in pediatric patients with obesity. RAC can be integrated into practice without compromising patient safety. Further research evaluating educational and fiscal aspects of RAC is ongoing.