Robotic Cholecystectomy: Outcomes, Safety, and Value in the Era of Advanced Technology

Abstract

Robotic cholecystectomy has been increasingly adopted across general surgery, driven by potential advantages in visualization, instrument articulation, ergonomics, and fluorescence-guided biliary identification. However, its clinical value relative to conventional laparoscopic cholecystectomy remains debated, particularly given higher procedural costs and mixed comparative safety data. This narrative review synthesizes contemporary evidence from 2020 to 2025 comparing robotic and laparoscopic cholecystectomy, with emphasis on operative outcomes, perioperative recovery, complex biliary disease, cost, and patient-reported outcomes. Current data suggest that robotic cholecystectomy is associated with modestly longer operative time during early adoption, although efficiency may improve with increasing procedural familiarity and standardized workflow. Conversion to open surgery is a recurrent favorable outcome reported with robotics, particularly in difficult gallbladders, obesity, acute inflammation, and reoperative or post-inflammatory settings. Intraoperative safety findings remain heterogeneous. Population-level analyses have raised concern regarding bile duct injury, whereas contemporary institutional, registry, and nonelective analyses report low or comparable bile duct injury rates. Postoperative recovery, length of stay, wound complications, readmission, quality of life, and patient satisfaction are generally similar between approaches, with limited evidence of modest early pain or recovery advantages in selected studies. Economic data are more consistent, showing higher direct and indirect costs for robotic cholecystectomy and unfavorable cost-effectiveness in routine elective disease. Overall, contemporary evidence does not support routine replacement of laparoscopic cholecystectomy with robotic cholecystectomy for uncomplicated gallbladder disease. The robotic platform may be best positioned for selective use in technically complex cases where enhanced visualization, articulation, and operative control could reduce conversion risk or facilitate minimally invasive completion. Future prospective, severity-adjusted studies incorporating surgeon experience, patient-centered recovery, and full cost accounting are needed to clarify where robotic cholecystectomy provides measurable clinical value.