Abstract / Summary
We analysed the learning curve and perioperative outcomes of 150 consecutive robotic cholecystectomies (RC) performed as a deliberate step-up after 1,000 prior laparoscopic cholecystectomies (LC) at a single institution, and contextualised findings within a systematic review of the literature. Retrospective analysis of prospectively collected data from 1,150 consecutive cholecystectomies (2010–2026). CUSUM analysis with piecewise linear regression characterised the learning curve. A systematic review of PubMed/MEDLINE, Embase, and Cochrane Library was conducted; random-effects meta-analysis and Egger regression assessed pooled outcomes and publication bias. Exclusion criteria, definition of semi-elective cases, and radiological workup are detailed in the Methods section. The institutional LC baseline series (2010–2022) comprised 1,000 procedures with a mean final-50-case operative time of 38.4 min (SD 9.2), a BDI rate of 0.3%, and a conversion rate of 1.4%. Zero RC procedures were performed during this period. The RC series (January 2023–June 2026; n = 150) demonstrated a compact CUSUM inflection at case 15 (IQR 12–19). Mean total operative time fell from 76.1 min in cases 1–20 to 42.6 min in cases 121–150 ( p < 0.001). Docking time decreased from 22.4 min (cases 1–5) to 5.8 min after case 28 ( p < 0.001). No conversions, BDIs, or 30-day mortalities occurred in the RC cohort. Overall 30-day Clavien–Dindo ≥ II complications were 2.0% (3/150) versus 3.1% (31/1,000) for LC ( p = 0.44). LOS was 1.1 ± 0.6 days for RC versus 1.4 ± 1.1 days for LC ( p = 0.07). RC increased from 0% of annual cholecystectomy volume (2017–2022) to 38.9% by the first half of 2026. The systematic review identified 37 comparative studies ( n = 412,847 patients); pooled analyses confirmed a significantly lower conversion rate with RC (OR 0.44, 95% CI 0.32–0.61; p < 0.001) and equivalent BDI incidence (OR 0.97, 95% CI 0.77–1.21; p = 0.78). RC after 1,000 prior LCs achieves a compact CUSUM learning curve (plateau ~ 15 cases), zero conversions and bile duct injuries, and safety equivalent to established LC. Prior laparoscopic volume is a quantifiable predictor of RC proficiency acquisition relevant to credentialing policy.