After-Hours Robotic Cholecystectomy Safe and Effective

BUENA VISTA, Fla.—Hospitals often restrict use of robotic surgical platforms to regular staffing hours, citing safety concerns. New research finding that robotic cholecystectomy performed outside of regular hours is safe and effective suggests this safety concern may not be justified.

Robotic cholecystectomy and robotic surgery in general are increasing in popularity, but there is limited access to robotic platforms for emergency procedures, despite studies suggesting emergency surgery should not be a contraindication for using the robotic platform, said Nawaf Hindosh, MD, a general surgery resident at Montefiore Medical Center and Albert Einstein College of Medicine, in New York City.

“Unfortunately, hospitals still limit access to the robotic platform during weekends and after hours—4 p.m. or 5 p.m.—due to safety concerns or staff availability. COVID-19 staffing issues also raised concerns about staffing shortages,” Dr. Hindosh said.

In 2024, his group, led by Emanuel Shapera, MD, published one-year data showing the 26 robotic cholecystectomies performed after regular staffing hours went as well as or better than 20 performed during regular staffing hours (Cureus 2024;16[2]:e54413). Dr. Hindosh presented the three-year data at the Society of Laparoscopic and Robotic Surgeons Minimally Invasive Surgery Week.

The research was a multi-institutional, retrospective study of 154 robotic cholecystectomies for acute cholecystitis performed by a single hepatobiliary-trained surgeon (Dr. Shapera); 63 of the surgeries were performed after regular hours and 91 during regular hours.

There were no significant differences in age and body mass index, and most patients were ASA class III. The after-hours group had a higher proportion of prior abdominal procedures, around 50%, compared with 30% in the regular-hours group, but this did not reach statistical significance.

Postoperatively, there were no significant differences in intraoperative blood loss, IV fluids given, length of stay (averaging about one day), 30-day mortality (none in either arm), or conversions to open (none in either arm). Also, although patients in the after-hours group had a greater proportion of prior abdominal surgeries—hence, more scarring and adhesions that would make surgery more challenging—there was no difference in operating time.

There were three complications in the after-hours patients and two in the regular-hours group.

“The conclusion of our study is that robotic cholecystectomy remains safe and effective after regular staffing hours, and that restricting general surgeons from accessing the robotic platform is unjustified. Despite having more abdominal procedures and scar tissue, the after-hours group did just as well—the robotic platform nullified this difficulty. A well-trained robotic surgeon can guide less-trained operating staff, thus no safety issues,” Dr. Hindosh said.

John Morrison, MD, a professor of surgery at Louisiana State University School of Medicine, in New Orleans, who moderated the session in which Dr. Hindosh presented the research, was not surprised by the findings.

“It was the same surgeon, so you’d expect to find the same results. But this is my bias: [We] general surgeons who cover elective and acute surgical needs have more experience and may be just as well equipped to do emergent cholecystectomies as acute care surgeons if not better. I think we’re better equipped to take care of these acute patients because we’re used to operating on the biliary tree. We don’t learn the procedure when it’s really hard, but when it’s easy, and we learn to look at the structures. We learn how to look at variety.”

Dr. Morrison also noted that use of the robotic platform after hours, done safely and effectively, would be attractive to hospital administrators in terms of bottom-line concerns.

“I think this is great to show, and is something you would think hospital administrators—especially financial people who want to get patients operated on and out of the hospital—would find interesting. Length of stay is what costs insurance carriers a ton of money. Getting the procedures done after hours instead of waiting until the next day is definitely something that administrators in hospitals should aim for, as it is better care and cost effective,” Dr. Morrison said.

Dr. Hindosh said the next steps for the researchers are to look at other procedures in different diseases and see how well patients do during and after hours, and possibly to recruit multiple surgeons to increase the number of cases and sample size.