Robotic-assisted cholecystectomy: Current status and future application

Abstract

Robotic-assisted cholecystectomy (RC) is increasingly common. However, its exact role remains undefined, with multiport conventional laparoscopic cholecystectomy (LC) being regarded as the established gold standard. This review aims to provide an overview of the evidence for RC and to define its current and future role. A literature search was performed on the PubMed and Medline databases to identify relevant articles published between 1994 and February 2022. The evidence obtained was summarised in a narrative style. Greater emphasis was placed on recent 10-year articles and studies of higher methodological quality. RC is noninferior to LC. The robotic platform facilitates the application of minimally invasive surgery in a way conventional laparoscopy cannot. LC remains appropriate for the majority of patients requiring cholecystectomy. The advantages of RC include inherent technical benefits, facilitating the learning of new surgical technology and its potential to reduce the risk of open conversion and bile leakage in certain populations (Mirizzi syndrome, complicated calculous disease, chronic liver disease and possibly malignancy). It also has increasing applicability to related biliary surgery. The limitations include cost, loss of tactile feedback and the learning curve associated with initial implementation. Future applications of robotic surgical systems include utilisation in difficult cholecystectomy, cases of biliary malignancy, telerobotic surgery and telementoring.