122 Outcomes of Robotic Cholecystectomy Across Parkland Grades in Urgent and Elective Settings

Abstract Background Robotic cholecystectomy enhances visualization and dexterity, but its performance across preoperative severity and urgency is underexplored. This study evaluates efficiency, safety, and outcomes using the Modified Parkland Grading Scale (PGS) in urgent and elective settings, assessing learning curve and comorbidity effects in the UK NHS. Method Retrospective cohort of 73 robotic cholecystectomies at King’s College Hospital, March 2024–May 2025. Data included demographics, PGS, urgency (urgent: ≤14 days; elective: ≤3 days), console time, Calot’s dissection, length of stay (LOS), conversions, complications, and readmissions. Non-parametric tests analysed outcomes (p<0.05). Medians (IQR) reported for non-normal data. Results Of 73 patients, 69.9% were elective (n=51), 30.1% urgent (n=22). PGS distribution: Grade 1 (57.5%), Grade 2 (19.2%), Grade 3 (16.4%), Grade 4 (5.5%), Grade 5 (1.4%). Console time increased with PGS, driven by Calot’s dissection (Grade 1: 13 min [IQR 9–20] vs. Grade 5: 60 min, p<0.001). LOS rose with PGS (Grade 1: 1 day [IQR 1–1] vs. Grade 5: 5 days, p=0.005). No conversions; two subtotal cholecystectomies. Complications: 1.4% (1 bile leak, Grade 4 urgent). Urgent cases had longer LOS (2 days [IQR 1–3] vs. 1 day, p<0.001). Sickle cell patients (n=3) had longer LOS (2 days [IQR 2–5], p=0.04). Console time decreased over time (Q1: 73 min [IQR 41–121] vs. Q5: 33 min, p=0.02). Conclusions Robotic cholecystectomy achieved no conversions, 1.4% complications, and median LOS of 1 day, outperforming laparoscopic benchmarks in complex and urgent cases, with NHS savings of £500–£1,000 per case. Multicenter RCTs are needed.