White paper: robotic cholecystectomy—new technology but safe principles still apply

Background: Increasing adoption of robotic cholecystectomy (RC) has prompted debate over its cost, access, safety, and training. Given the historical lessons learned during the transition from open to laparoscopic cholecystectomy (LC), it is important that we now evaluate RC within the framework of safe cholecystectomy principles. Methods: This white paper reviews existing literature and expert consensus on RC credentialing practices, safety protocols, adjunctive imaging, technological limitations, global applications, and modality advantages and disadvantages. Results: Evidence on RC vs. LC outcomes is mixed, and current data suggest the need for RC structured training, simulation, and competency-based evaluation. RC offers several advantages such as enhanced visualization, improved ergonomics, and potential benefits in complex anatomy, surgeon longevity, and rural or resource-limited settings. However, challenges remain in RC, including inconsistent credentialing, limited standardization of training, potential higher costs as compared to LC, and variable adherence to safe cholecystectomy principles such as the critical view of safety (CVS). Conclusion: Safe cholecystectomy principles must remain paramount in all forms of cholecystectomy. For RC adoption, there is opportunity to standardize training and incorporate thoughtful credentialing with responsible integration of technology.