Primarily Gasless Robot-Assisted Cholecystectomy in Dogs: A Cadaveric Feasibility Study

Gallbladder disease is a common cause of morbidity in dogs, and cholecystectomy remains the definitive treatment in many cases. Although minimally invasive approaches offer recognized advantages, their adoption is limited by technical complexity and by the physiological effects of carbon dioxide (CO₂) pneumoperitoneum. This cadaveric study evaluated the feasibility of performing primarily gasless robot-assisted cholecystectomy under abdominal wall suspension in five canine cadavers. A normobaric operative field was established using a suspension device combined with the VersiusTM robotic platform. "Primarily gasless" was operationally defined as abdominal wall suspension without continuous pneumoperitoneum, allowing short-duration low-pressure CO₂ insufflation (≤8 mmHg) exclusively as a rescue maneuver when exposure was insufficient. Surgical feasibility was assessed through structured case-level reporting, including docking time, operative time, exposure quality of the hepatocystic triangle (predefined ordinal scale), clipping feasibility, intraoperative events, instrument exchanges, and need for rescue CO₂ insufflation. All procedures were completed in the cadaveric specimens. In three cadavers, the procedure was performed entirely without CO₂. In two cadavers, a single short-duration low-pressure CO₂ insufflation (6-8 mmHg for 3-5 minutes) was applied as a rescue maneuver. Adequate or optimal visualization of the hepatocystic triangle was achieved in all cases, and no intraoperative injuries occurred. These findings support the technical feasibility of a primarily gasless robotic approach in a canine cadaveric model. Controlled in vivo studies are required to evaluate the physiological impact, perioperative outcomes, and translational applicability before clinical implementation.