Robotic adhesiolysis: current evidence, technical considerations, and future directions

Adhesiolysis is a technically demanding component of abdominal and pelvic reoperation. Robotic platforms may offer theoretical advantages in complex dissections; however, the clinical evidence specific to robotic adhesiolysis is limited. This review summarizes the current evidence, robotic-specific technical considerations, clinical rationale, patient selection, and future research priorities for robotic surgery in operations requiring adhesiolysis. A targeted narrative review of peer-reviewed literature on adhesion-related morbidity, adhesive small bowel obstruction (ASBO), laparoscopic adhesiolysis, and robotic surgery in patients with adhesions was performed. Current clinical data suggest that robotic surgery may reduce the conversion to open surgery due to adhesions in selected reoperative abdominal surgeries, particularly in expert hands and specific colorectal settings. However, outcomes beyond conversion, such as enterotomy rates, length of stay, and postoperative complications require further investigation. Successful robotic adhesiolysis relies on meticulous technical execution, including safe abdominal access, strategic port mapping, and appropriate instrument selection. Patient selection must carefully distinguish between elective reoperative surgery and emergency ASBO cases. Robotic adhesiolysis is a promising minimally invasive approach. Current evidence supports the cautious use of this approach in carefully selected patients. Future progress depends on standardized reporting, objective adhesion grading, prospective registries, and comparative studies that evaluate clinically relevant outcomes.