Laparoscopic vs. robotic cholecystectomy for patients with cirrhosis: A propensity score-matched, single center analysis.

Patients with cirrhosis have increased rates of gallstone formation. While laparoscopic cholecystectomy (LC) is known to be safe in cirrhosis, perioperative morbidity remains higher than the general population. Prior work has suggested that robotic cholecystectomy (RC) may improve outcomes for patients with cirrhosis. This was a retrospective propensity score-matched (PSM) analysis of patients with cirrhosis undergoing cholecystectomy within an academic health system between January 2015 and December 2025. The primary outcome was rate of Clavien-Dindo grade IIIa or higher complication. Demographics and clinical characteristics/outcomes were compared using standard statistical techniques. The total cohort included 139 patients: 108 (77.6%) LC and 31 (22.3%) RC. Prior to PSM, RC patients had significantly higher MELD scores (11 vs. 10, P = 0.024), greater prevalence of ascites at surgery (35.5% vs. 14.8%, P = 0.018), and more elective case status (96.8% vs. 72.2%, P = 0.003). After PSM, 61 LC and 31 RC patients remained for analysis, without significant difference in MELD score or elective status (all P > 0.05). In the PSM cohort, there was not a significant difference in major morbidity rate by approach (4.8% vs. 6.5%, P > 0.9), while estimated blood loss (10 vs. 25 mL, P < 0.001) and open conversion rate (0 vs. 12.9%, P = 0.049) were significantly lower for RC. RC was associated with equivalent perioperative outcomes to LC in patients with cirrhosis in this study. Larger studies are warranted to define the optimal approach to cholecystectomy in this population.