Gallbladder problems can significantly impact daily life, leading to symptoms like severe abdominal pain, nausea, vomiting, and digestive disturbances. When gallstones or other gallbladder-related issues cause significant discomfort, gallbladder removal surgery (cholecystectomy) becomes necessary. There are a few different approaches to this operation

1. Laparoscopic Surgery

This is the gold standard for removing the gallbladder. It involves four small cuts in the abdomen and key-hole surgery. Most people can go home the same day or next day and this is the commonest approach to gallbladder surgery in developed countries.

• Procedure
  • Less invasive; small cuts in the belly.
  • Uses a tiny camera and surgical tools to operate on the gallbladder.
• Benefits
  • Faster recovery, less pain, and shorter hospital stay.
  • Suitable for most patients with uncomplicated gallbladder issues.

2. Open Surgery (Open Cholecystectomy):

All laparoscopic surgery comes with the implicit risk that the operation may not be able to be completed this way and may need to be ‘converted’ to open. This is regarded as a principle of safety rather than a failure. In the developed world, open cholecystectomy results if an operation cannot be completed laparoscopically or in complex cases where surgery is begun ‘open’ from the outset.

• Procedure
  • A single large incision in the abdomen is made to remove the gallbladder. This is usually in the upper abdomen (above the umbilicus) or under the ribs on the right side.
  • Longer recovery time and more pain compared to laparoscopy.
• Considerations
  • Reserved for complex cases or when laparoscopic or robotic approaches are not feasible.

3. Robotic Surgery

Most cholecystectomies can be safely performed laparoscopically with excellent patient outcomes. No role has been established to date for routine use of the robot for gallbladder removal. However, in complex cases such as in gallbladder cancer, patients with liver cirrhosis, previous attempted cholecystectomy by a different surgeon, the robotic approach increases the likelihood of completing the approach without needing a large incision and thus allows patients to recover faster.

One caveat is that in some published literature, a higher rate of complications has been observed with robotic surgery likely reflecting the inexperience of the surgeon. Thus, it is important that you enquire about the surgeon’s robotic training and experience and enquire about their outcomes from robotic surgery.

In conclusion, robotic gallbladder surgery is appropriate in highly selected cases when performed by a dedicated, experienced surgeon with formal robotic surgery training. Simply using the robot does not guarantee a superior outcome in these scenarios and may cause harm if the surgeon is inexperienced.

• Procedure
  • An advanced form of keyhole surgery
  • Robotic systems provide improved accuracy, flexibility, and control during surgery.
  • Surgeons can manipulate robotic arms with seven degrees of motion, leading to precise movements.
• Advantages
  • Reduced blood loss, pain, and infection in some studies (other studies suggest no difference when compared to laparoscopy)
  • Robotic cholecystectomy may have a lower risk of conversion to open surgery.
  • Early hospital discharge.
  • Quicker return to daily routine.
• Considerations
  • Availability of robotic systems varies by hospital.
  • More expensive than laparoscopy
  • Outcomes depend on skill and experience of surgeon.
  • Not always necessary for straightforward cases.

Remember, robotic cholecystectomy isn’t performed by a robot—it’s a skilled surgeon using robotic assistance for enhanced precision. If you’re considering gallbladder surgery, consult with your healthcare provider to determine the best approach for your specific case.