Robotic cholecystectomy during surgical training: learning curve and perioperative outcomes of 441 consecutive cases...

Robotic cholecystectomy (RC) has been increasingly adopted in general surgery; however, evidence on its role and performance within structured training programs remains limited. This study aimed to evaluate the learning curve and perioperative outcomes of RC in a high-volume teaching center. A single-center retrospective study was conducted in a high-volume teaching hospital including all consecutive RCs performed between October 2019 and April 2025 by surgeons and trainees without prior robotic experience. All procedures were carried out within a structured training program under senior supervision. The primary outcome was the learning curve, assessed using cumulative sum (CUSUM) analysis of operative time. Secondary outcomes included perioperative results and subgroup analyses according to operator type and patient-related factors. Multivariable regression analysis was performed to identify factors influencing operative time. A total of 441 patients were included. Mean operative time was 64 ± 21 min. No intraoperative injuries or conversions to open or laparoscopic surgery occurred. Postoperative complications were observed in 6 patients (1.4%), with a readmission rate of 0.9%. CUSUM analysis identified four phases: an initial variability phase (1-13 cases), a stabilization phase (14-30), a performance improvement phase (30-50), and a late plateau. Operative time was independently associated with adhesiolysis (B = 9.382; p < 0.001) and male sex (B = 7.139; p < 0.001), whereas operator type was not significant. Outcomes were consistent across subgroups, including obesity and ASA class. Comparable learning patterns were observed between surgeons and trainees. In high volume training centers, RC can be safely implemented within surgical training programs, showing a relatively short learning curve and low complication rates. These findings support its use as a reproducible platform for robotic training and suggest its suitability as an entry-level procedure in robotic surgery.