Robotic cholecystectomy for acute cholecystitis shows higher bailout rates compared to laparoscopic approaches, impacting cost-effectiveness.

• Bailout rate was 1.7% for robotic vs. 1.4% for laparoscopic cholecystectomy, with robotic surgery having higher odds of conversion to open (1.61) and subtotal cholecystectomy (2.02).
• However, fewer postoperative interventions were needed after robotic surgery (3.1% vs. 7.7% for endoscopic biliary and 2.3% vs. 7.5% for surgical).

Despite these findings, 1-year costs were significantly higher for robotic cholecystectomy ($29,702 vs. $24,483), which may limit its utility in acute cases.