OBJECTVE

To review the available paucity of literature on robotic subtotal cholecystectomies (STC) and evaluate feasibility, operative technique, and perioperative outcomes.

BACKGROUND

• Laparoscopic STC is a recognized “bailout” strategy during challenging cholecystectomies. However, it results in a high post-op complication rate ie. bile leak or need for ERCP.

• Robotic STC are not as common as laparoscopic and may facilitate easier reconstituting closure rather than fenestrating techniques to decrease post-op complications

• The role of robotics in STC remains incompletely defined.

METHODS

• Systematic review with PRISMA guidelines.

• Databases searched: PubMed/MEDLINE, Google Scholar, PMC.

• Search through August 2025.

• Inclusion: peer-reviewed human studies involving robotic STC.

• Five studies met inclusion, providing data from 46 robotic subtotal cholecystectomies.

KEY FINDINGS

• Across 5 studies of 46 robotic STC:

➢ 72% underwent reconstituting closure.

• Robotic STC was associated with fewer post-operative ERCPs vs laparoscopic:

➢ 11.1% vs 27.1%, P = 0.03.

• Multicenter data showed:

➢ Reduced conversion to open: 1.1% vs 1.9%, P = 0.03. ➢ No bile duct injuries reported across all studies.

INTERPRETATION

• Robotic STC appears safe and effective for challenging gallbladders.

• Robotic STCs are more likely to have reconstituting closure (72%).

• Robotic approach linked to fewer postoperative ERCPs and conversions to open.

• Larger studies needed to adequately assess outcomes

REFERENCES

1. Elshaer M, Gravante G, Thomas K, Sorge R, Al-Hamali S, Ebdewi H. Subtotal Cholecystectomy for “Difficult Gallbladders.” JAMA Surgery. 2015;150(2):159. doi:https://doi.org/10.1001/jamasurg.2014.1219

2. Braschi C, Tung C, Tang A, et al. Early Outcomes of Subtotal vs Total Cholecystectomy for Acute Cholecystitis. JAMA Surgery. 2022;157(11):1062. doi:https://doi.org/10.1001/jamasurg.2022.3146

3. Bronikowski D, Lombardo D, DeLa’O C, Szoka N. Robotic Subtotal Cholecystectomy in a Geriatric Acute Care Surgery Patient with Super Obesity. Chen W, ed. Case Reports in Surgery. 2021;2021:1-

4. doi:https://doi.org/10.1155/2021/9992622

4. Greenberg S, Abou Assali M, Li Y, et al. ROBOtic Care Outcomes Project for acute gallbladder pathology. The journal of trauma and acute care surgery. 2024;96(6):971-979. doi:https://doi.org/10.1097/TA.0000000000004240

EVIDENCE GRID– ROBOTIC SUBTOTAL CHOLECYSTECTOMY

Author(Year)	Design	nRSTC	Technique	KeyOutcomes
Bronikowski(2021)	Casereport	1	Fenestratingsubtotal;posteriorwallleft,ICGused	Morbidly-obesepatient,POD1discharge,nocomplications
Zhu(2023)	Caseseries(complexcases)	3	1fenestrating,1reconstituting,1withfistularepair;ICG,fundus-first	Noconversions,noinjuries,rapidrecovery
Stefanishina(2025)	Retrospectivecohort(roboticvslaparoscopic)	18	72%reconstitutingvslap100%fenestrating	Fewerpost-opERCP(11.1%vs27.1%,P=0.03);similarORtime/LOS
Patel(ACSCaseRev,2025)	Casereport	1	FenestratingsubtotalwithconcurrentMorgagniherniarepair	Uncomplicatedrecovery;first report in hemorrhagic cholecystitis
Greenberg(2024)	Multicenterretrospective(acutegallbladder,JTraumaAcuteCareSurg)	23	Database-defined;fenestratingvsreconstitutingnotspecified	Roboticsubtotal 0.7%vslap 0.5%;↓openconversion(1.1%vs1.9%);similarcomplications&cost