Optimizing robotic cholecystectomy: improving cost-effectiveness with non-inferior safety and efficacy

Achieving the critical view of safety during cholecystectomy is paramount for preventing bile duct injury but contingent on effective gallbladder retraction. Although robotic platforms offer enhanced dexterity and visualization, they present an opportunity to improve the static retraction methods common in laparoscopy. Herein, we describe our advanced dynamic multidimensional retraction (DMR) technique for three-port robotic cholecystectomy. This method uses the external joints of the robotic arms to provide continuous, multi vector exposure of the triangle of Calot, aiming to enhance surgical safety and efficiency. We conducted a retrospective review of the first 131 consecutive patients who underwent a three-port robotic cholecystectomy using our standardized DMR technique between January 2023 and July 2025. All procedures were performed on the DaVinci Xi or X platform by four surgeons during their initial robotic case series. Key demographic, intraoperative, and postoperative data were analyzed. Primary outcome measures included console times, length of hospital stay, intraoperative complications, and conversion rate to other surgical techniques. We performed 131 standardized robotic cholecystectomies via three-arm robot deployment by four teams. The mean patient age was 53 years; 50 were men and 81 were women. All teams started their robotic surgeries sequentially in a 4-months period in 2023. Most cases were elective, seven patients had acute cholecystitis, and 35 patients had a cholecystectomy integrated with other procedures like intraoperative cholangiogram, liver biopsy, repair of postoperative ventral hernia and one case of internal hernia repair after bariatric surgery. The mean console time was 57 min. There was no conversion to other surgical techniques. DMR is a safe and reproducible technique for three-port robotic cholecystectomy. By leveraging the robotic platform capabilities, our method provides non-inferior exposure of the critical anatomy. This advanced robotic approach represents a valuable tool for optimizing the surgical field and may improve safety and efficiency during robotic cholecystectomy. Further investigation in larger, comparative studies is warranted.