Robotic-assisted cholecystectomy in children is associated with faster gastrointestinal recovery: a comparative study.

BACKGROUND

The role of robotic-assisted cholecystectomy in paediatric patients remains incompletely defined, particularly regarding postoperative recovery and gastrointestinal function. This study aimed to compare perioperative outcomes and early recovery between robotic-assisted and conventional laparoscopic cholecystectomy in children.

METHODS

A single-centre retrospective comparative cohort study was conducted at a tertiary paediatric referral centre. Consecutive patients (≤18 years) undergoing cholecystectomy for benign gallbladder disease were included and divided into two groups based on surgical approach: pre-robotic (January 2023-December 2024) and robotic (January 2025-December 2025). Demographic, intraoperative, and postoperative outcomes were analysed. Continuous variables were compared using the Mann-Whitney U test and categorical variables using Fisher's exact test.

RESULTS

A total of 28 patients were included (13 pre-robotic, 15 robotic). Baseline characteristics were comparable between groups. Median operative time was significantly longer in the robotic group (2:22 h vs. 1:33 h; p < 0.001), while length of hospital stay was significantly shorter (2 vs. 4 days; p = 0.003). No conversions to open surgery or surgical site infections were observed. Postoperative complications were rare and comparable between groups (7.7% vs. 0%; p = 0.46). Analgesic requirements, VAS scores, and PEWS values were similar. Early gastrointestinal recovery was significantly improved in the robotic group. Early oral feeding within 24 h occurred in 100% of robotic cases versus 69.2% in the pre-robotic group (p = 0.041). Passage of flatus within 24 h was observed in 93.3% versus 30.8%, respectively (p = 0.002).

CONCLUSIONS

Robotic-assisted cholecystectomy is a safe and feasible approach in paediatric patients, with perioperative outcomes comparable to conventional laparoscopy. Despite longer operative times, the robotic approach was associated with shorter hospital stay and faster recovery of bowel function. These findings suggest a potential advantage of robotic surgery in promoting early postoperative recovery. Larger prospective studies are needed to confirm these results and define the role of robotics in paediatric cholecystectomy.