Beyond individual complications: textbook outcome in elective minimally invasive cholecystectomy and the role of robotic approach.

Textbook outcome (TO) summarizes several desirable perioperative results within a single endpoint, but its use in cholecystectomy remains uncommon. Comparisons between robotic cholecystectomy (RC) and laparoscopic cholecystectomy (LC) have generally relied on individual outcomes. We therefore examined TO after elective minimally invasive cholecystectomy and assessed whether surgical approach was associated with overall perioperative performance and postoperative recovery. We retrospectively reviewed consecutive patients who underwent elective minimally invasive cholecystectomy from January 2024 through December 2025 at a single institution. TO required no conversion to open surgery, an uncomplicated intraoperative and postoperative course, no subtotal cholecystectomy, no unplanned postoperative imaging or reintervention, no ICU admission or readmission, no mortality, and discharge before postoperative day 2. Multivariable logistic regression was used to evaluate factors associated with TO and timely postoperative recovery, supplemented by inverse probability of treatment weighting (IPTW) to account for baseline differences between the RC and LC groups. The elective cohort comprised 257 patients, including 119 RC and 138 LC procedures. TO was achieved more frequently after RC than LC (91.6% vs. 73.9%, p < 0.001), and RC remained associated with TO achievement after multivariable adjustment and IPTW. Although delayed postoperative recovery was the most common reason for TO failure, RC was not independently associated with timely recovery after adjustment. In the acute cholecystitis subgroup, perioperative outcomes did not differ significantly between approaches. TO provides an integrated measure of perioperative outcomes after elective minimally invasive cholecystectomy. RC was associated with a higher likelihood of achieving TO after multivariable adjustment and IPTW, although further multicenter studies are needed to validate these findings.