Robotic Surgery in Acute Care: A Systematic Review of Its Role in Visceral Trauma and Emergency General Surgery

Emergency laparotomies carry profound physiological morbidity, yet the adoption of minimally invasive surgery (MIS) in acute care remains hindered by laparoscopic limitations. While robotic platforms offer 3D visualization and wristed articulation to overcome these barriers, their application in emergency general surgery (EGS) and visceral trauma remains controversial. This systematic review aims to define the clinical and physiological boundaries of robotic surgery in the acute care setting. A PRISMA-compliant systematic review was conducted using PubMed/MEDLINE, Embase, Scopus, the Cochrane Library, and Web of Science from database inception through March 2026. Eligible studies included adult patients undergoing robotic surgery for EGS or visceral trauma. To minimize analytical confounding, studies were synthesized within two predefined cohorts: EGS and visceral trauma. Primary outcomes included conversion to open surgery, technical success, and timing of intervention. Secondary outcomes included operative time, length of hospital stay, postoperative morbidity, and cost-related outcomes. Thirty-six primary studies met the inclusion criteria, comprising 22 EGS studies and 14 visceral trauma studies. Within the EGS cohort, several comparative studies reported lower conversion-to-open rates with robotic surgery (0.0%-11.5%) compared with conventional laparoscopy (0.0%-28.7%), particularly in acute cholecystitis and complex hernia repair. Operative times were generally longer in robotic procedures, reflecting platform setup and docking requirements, whereas some studies reported shorter postoperative hospital stays. The visceral trauma literature consisted predominantly of case reports, case series, and observational studies. Robotic intervention was almost exclusively performed in hemodynamically stable patients during a delayed or semi-acute phase of care, with a median reported intervention interval of approximately 76 hours in the largest registry analysis. Reported applications were concentrated in complex diaphragmatic, thoracic, pancreatic, and pelvic reconstructions, with high rates of successful completion via minimally invasive techniques. Current evidence suggests that robotic surgery is a feasible minimally invasive option in selected acute care scenarios. In EGS, robotic platforms may facilitate completion of complex procedures while maintaining low conversion rates in appropriately selected patients. In visceral trauma, robotic surgery appears most applicable during delayed or semi-acute reconstruction following physiological stabilization rather than during damage-control interventions. Further prospective studies are required to define patient selection criteria, clinical effectiveness, and cost-effectiveness in acute care surgery.