Complex cases, endoscopic interventions, personalized techniques, and risk control: a bibliometric review of minimally invasive gallbladder surgery

Abstract

Gallstones are a growing global public health issue linked to obesity and metabolic syndrome, and they impose substantial healthcare burdens through complications such as cholecystitis. Minimally invasive surgery is now widely used, but technical optimization and careful risk assessment remain important clinical challenges. The literature on minimally invasive surgery for cholecystolithiasis published from 2015 to 2025 was retrieved from the Web of Science Core Collection, and, after strict screening, 1688 articles were included. Biblioshiny, CiteSpace, and VOSviewer were used for bibliometric analyses of journal output, national and institutional collaboration, keyword co-occurrence, and thematic clustering, with statistical significance set at P < 0.05. Research activity in this field increased, with growing attention to complex cases. The focus shifted from validation of basic techniques toward subtotal cholecystectomy as a bail-out option for severe adhesions and high-risk patients. Endoscopic techniques were frequently linked to postoperative management of bile-duct stones, although bibliometric data alone cannot prove reduced complication rates. Surgical research increasingly emphasized precision and individualization, including port optimization and gallbladder-preserving approaches in selected patients. Risk management was addressed across the preoperative, intraoperative, and postoperative continuum. This study identifies four bibliometrically derived priorities for future research and clinical translation: strengthening evidence-informed training for complex-case strategies, refining endoscopic-surgical pathways for bile duct stones, standardizing emerging port and robotic techniques, and establishing long-term safety registries for subtotal cholecystectomy and gallbladder-preserving approaches.