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Gallbladder Disease & Robotic Repair

A guide to gallstones, gallbladder pain, and what robotic gallbladder removal involves.

Written and reviewed by Carlos Rodriguez, DO, MBA, FACS. Last reviewed October 1, 2026.

📄 Gallbladder Disease – Patient Guide (PDF) Call for Appointment

The short version

Classic gallbladder pain hits after fatty meals, in the upper right abdomen, sometimes spreading to the back or right shoulder blade.
Painful stones, inflammation, or a gallbladder that empties poorly (confirmed by HIDA scan) are the usual reasons to remove it.
Removal is typically same-day ; most people return to work in 1–2 weeks.
There is no permanent diet afterward. Most people eat normally within a few weeks.

A quick summary. The full details are below, and none of it replaces an exam.

What does the gallbladder do?

Your liver makes a fluid called , which helps your body break down fat from food. Your gallbladder is a small sac that stores and concentrates that bile. After you eat, especially something fatty, your gallbladder squeezes and sends bile down a tube (the ) into your small intestine, where it mixes with food and helps digestion.

If a stone blocks that tube, bile can't get out. The pressure builds up inside the gallbladder, and that's what causes pain.

Biliary anatomy diagram showing liver, gallbladder, bile ducts, and common bile duct

How do gallstones form?

are hard little particles that form inside the gallbladder when the bile is out of balance. There are three kinds:

Cholesterol stones: the most common type. There's too much cholesterol in the bile, and not enough of the substances that keep it dissolved, so it crystallizes into a stone.
Pigment stones: made from bilirubin, a substance left over when red blood cells break down. Certain blood disorders or liver problems raise the risk.
Mixed stones: a combination of both.

Why does losing weight quickly cause gallstones? When your body burns fat fast, whether from a strict diet, weight-loss medication, or bariatric surgery, your liver dumps extra cholesterol into your bile. Your gallbladder also tends to empty less often, so the bile sits and gets thicker. Both of these make stones more likely to form.

What about GLP-1 medications like Ozempic or Wegovy?

GLP-1 medications, used for diabetes and weight loss, can slow down how well your gallbladder empties. Combined with rapid weight loss, this raises your risk of forming gallstones. If you're on one of these medications and develop upper-abdomen pain after meals, it's worth getting checked.

What does gallbladder pain feel like?

Classic gallbladder pain (called ) shows up after a fatty meal. It's usually felt in the upper right part of your abdomen, and it can spread to your back or right shoulder blade. If a stone stays stuck, the gallbladder can become inflamed or infected (a condition called cholecystitis), or a stone can travel further and cause , a bile duct infection, or . Any of these need prompt medical attention.

What if my scans don't show stones, but I still have the pain?

Some people have all the same symptoms without any visible stones. This is called biliary dyskinesia: the gallbladder isn't squeezing or emptying properly. We diagnose this with a HIDA scan, a test that measures how well your gallbladder empties. If emptying is poor and your symptoms match, removing the gallbladder is often still the right answer.

When is gallbladder removal recommended?

Painful gallstones (symptomatic cholelithiasis)
Gallbladder inflammation (cholecystitis)
Gallbladder polyps larger than 1 cm, or growing on repeat ultrasounds
Biliary dyskinesia (poor emptying, confirmed by HIDA scan)
Biliary hyperkinesia (excessive emptying, confirmed by HIDA scan)
Gallbladder infection
Stones that have moved into the main bile duct (choledocholithiasis)
Gallstone pancreatitis

How robotic-assisted repair works

During robotic surgery, Dr. Rodriguez sits at a console near the operating table and controls every robotic instrument directly, while the surgical team stays at your side throughout. The robotic system provides a high-definition, 3D view inside your abdomen, allowing precise movement through just a few small incisions.

Anesthesia: you're fully asleep for the entire procedure.
Getting in: usually four small incisions are made. Entry into the abdomen is done with a see-through device, so each layer of the abdominal wall is identified as it's entered. Once inside, the abdomen is gently filled with air, and the area right below the entry point is checked to confirm the colon, small intestine, and stomach weren't injured.
Robotic setup: robotic arms are connected to the instruments placed through those incisions.
Removal: the gallbladder is carefully freed and removed.
Closure: incisions are closed with stitches and surgical glue.

How does Dr. Rodriguez reduce risk during surgery?

Every operation has some risk. Here's specifically what's done to lower it:

Critical View of Safety: the key structures (cystic duct and cystic artery) are clearly identified and freed of surrounding tissue before anything is cut, which is the single biggest safeguard against bile duct injury.
Fluorescent cholangiography: a green dye, given through an IV before surgery, glows under special light so the bile duct anatomy is visible in real time.
Intraoperative cholangiogram: an X-ray dye study, used selectively, to confirm anatomy and rule out retained stones.
High-definition 3D visualization from the robotic system itself.
Continuous monitoring of your vital signs throughout the case.

Risks to know about

Bleeding or infection
Injury to nearby organs (liver, intestines, blood vessels)
Injury to intestines, blood vessels, or nerves during initial entry and during the dissection process. This risk is small, but does vary based on anatomy and scar tissue
Injury to the bile duct system, or a bile leak
Blood clots
Reaction to anesthesia
Need to convert to an open operation
Pain at the incision used to remove the gallbladder (usually just left of the navel)
Loose stools after surgery

Why does diarrhea happen after gallbladder removal?

Once the gallbladder is gone, there's no longer a storage tank for bile. Instead, it trickles continuously from the liver into your intestine. That steady trickle can act like a mild laxative for some people. It's usually mild and improves with time; diet changes or medication can help if it doesn't.

Recovery: what to expect

Hospital stay: most patients go home the same day.
Pain control: a mix of Tylenol (acetaminophen), Celebrex (celecoxib), Robaxin (methocarbamol), and an opioid like Ultram (tramadol) or Roxicodone (oxycodone) if needed, for about 3 days.
Diet: start with clear liquids, then return to your normal diet. Add fatty foods back gradually, since you no longer have a bile reservoir.
Activity: light activity right away; nothing over 10 pounds until your 2 week visit, when we reassess.
Wound care: you can shower the day of surgery. Incisions are closed with surgical glue, so keep them dry and pat (don't rub) after showering. Do not submerge incisions in a pool, tub, or other body of water for at least 4 weeks, and keep them out of direct sun for 6 months to avoid discoloration.
Back to normal life: most people return to work within 1–2 weeks.

For more information, see Recovery and getting back to life.

Call our office if you notice:

Fever over 101°F, or chills
Redness, swelling, or drainage from an incision
Severe abdominal pain
Persistent nausea or vomiting
Yellowing of your skin or eyes

If it's after hours, your call will be routed to our answering service. The on-call surgeon or PA will receive your message and contact you.

For uncontrolled pain, shortness of breath, chest pain, or inability to keep fluids down, seek urgent medical attention right away rather than waiting for office hours.

Want to see it in action?

This video shows footage from an actual surgery. Viewer discretion is advised.

Patient handouts

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Animated guide

Your gallbladder, from bile to surgery

How the gallbladder works, what goes wrong when stones cause trouble, how I take it out, and what life is like without it. Press Next step to go at your own pace, or Play all to watch it straight through.

The liver, gallbladder, bile ducts, pancreas and duodenum — Drawings simplified, not to scale.

Step 1

The neighborhood

Read the whole script

Here is the neighborhood: the liver, the right and left hepatic ducts, the common hepatic duct, the cystic duct, the gallbladder, the common bile duct, the pancreatic duct, and the ampulla of Vater, where they all empty into the duodenum.
One of the liver's main jobs is to produce bile. You need bile to help you digest your fats.
Bile leaves the liver through the right and left hepatic ducts, which join to form the common hepatic duct. Then bile goes into the gallbladder through the cystic duct, where it waits.
When you eat a fatty meal, it goes into your stomach and then your small intestine. Special cells there send a chemical signal to the gallbladder, and that signal makes it squeeze.
Bile leaves the gallbladder through the cystic duct and goes down the common bile duct. It meets the juices from the pancreas and goes into the small intestine, where it helps digest the fat.
Sometimes stones form in the gallbladder. Just because you have stones is not a reason to take out the gallbladder. It is when those stones start causing trouble.
A stone gets caught in the neck of the gallbladder. When the gallbladder squeezes against that stone, it causes pain and discomfort. If the stone falls back into the gallbladder, the pain goes away.
If the stone stays stuck in the neck, bacteria can overgrow inside the gallbladder. That is cholecystitis.
Sometimes stones leave the gallbladder and get caught in the duct. That causes pain and discomfort, and it can turn your eyes yellow. If infection sets in, that is cholangitis.
Sometimes a stone passes by the pancreas and causes the pancreas to become inflamed. That is pancreatitis.
I do this operation with the robot. In this picture I am sitting at the console, right next to the operating room table. The robot's instrument tips are really small and rotate fully anywhere inside the abdomen, even underneath the gallbladder. The camera sits an inch or two from the gallbladder, looking up at it. The robot gives me better vision and better dexterity.
There are four incisions: one high on the left at Palmer's point, and incisions two, three and four at about the level of the belly button.
After entering the abdomen at Palmer's point, I fill the abdomen with carbon dioxide. I then look around the entry site to make sure there are no injuries to the stomach, small intestine, or colon. I then place the remaining ports and dock the robot.
I grab the top of the gallbladder and take it up over the liver. I grab the bottom and take it out to the side. That makes the cystic duct come off at a right angle to the main duct.
I find the cystic duct and place two clips on the side that stays behind and one clip on the side that stays with the gallbladder. An artery runs alongside the duct (the cystic artery). It gets one clip, and I seal the rest of it with electricity and cut where it was sealed.
Then I take the gallbladder off the liver.
The gallbladder is placed into a bag and comes out through the incision to the left of the belly button. That incision is usually the most uncomfortable of the four, because I often have to make it a little bigger. If I do, I put in a stitch to lower the chance of a hernia forming there.
If I were to place a clip right here, on the common bile duct, the liver would still produce bile, but the bile would have nowhere to go.
The gallbladder always tapers to a point, and off that point comes the cystic duct. I clear all the connective tissue out of the triangle of Calot, so that only two structures go up to the gallbladder: the duct and the artery. This is called the critical view of safety, and the photo shows one from my own operations. That is when I place my clips.
In the holding area before surgery, you get a green dye called indocyanine green, or ICG. It leaves your body through the bile system, and a button on the robot makes anywhere the dye is glow green. It is pretty cool. I can usually see the common hepatic duct, the common bile duct and the cystic duct without much difficulty.
If I still have trouble identifying the critical view of safety, I put a clamp across the bottom of the gallbladder, pass a needle into the gallbladder, inject a different dye, and take an x-ray. The picture shows that x-ray, called a cholangiogram: the bile ducts filled with dye.
There are times when I have difficulty just seeing the gallbladder when I enter the abdomen. Here is one case. The gallbladder is covered by omentum. When inflammation blocks the normal view, I have other techniques I can use to safely remove the gallbladder. One is the open book: I take the gallbladder off the liver from the middle out, like opening the page of a book, get behind it, and work down to where it comes to a point. Another is to start at the top of the gallbladder and work down. Rarely, I make the old fashioned open incision and use my hands.
Sometimes, especially with severe inflammation, I take out as much of the gallbladder as I can, remove all the stones I see, and leave a drain behind. If the drain puts out bile in the next 24 to 48 hours, that is a bile leak. I ask a GI specialist to place a stent, which is like a straw, inside the common bile duct. It brings bile straight from the liver to the intestine, so the area can scar down. The illustration shows the "subtotal cholecystectomy." The green structure is a small remnant of remaining gallbladder.
After gallbladder surgery, bile slowly trickles into your small intestine. You no longer have that reservoir of bile to help digest fat, so in the very beginning, some people develop abdominal cramping when eating fatty meals. Take it slow at first. Over the first few days, slowly add back fatty meals into your diet to allow your body time to adjust.
In the very beginning some folks have diarrhea. If it lasts more than two weeks, let us know. I can give you cholestyramine. It acts like a sponge that soaks up the bile, because too much bile reaching the colon can cause diarrhea.
I bury all the stitches under the skin and put Dermabond, a super glue for the skin, on the outside. The wounds are watertight, so you can shower the day of surgery. Most folks like to go home and take a nap.
Some patients have pain behind the shoulder blade. Why? Well, air trapped under the diaphragm can irritate the nerve that moves the diaphragm when you breathe. That nerve shares its wiring in the spinal cord with nerves from the shoulder, so your brain feels the irritation as shoulder pain. Getting up out of bed and walking around helps your body absorb the air.
Any time we cut the skin, bleeding and infection are possible. To lower the chance of bleeding, I seal the small vessels I come across with electricity. To lower the chance of infection, we clean the skin with soap, every instrument is sterile, and you get antibiotics before we start.
That is the story of your gallbladder, from how bile works to life after surgery. If you have questions, read more on my blog, call the office at (817) 250-7030, or ask me during your appointment or in the pre-op holding area on the day of surgery.