BACKGROUND
Robotic-assisted surgery has become an established component of elective minimally invasive surgery, yet its role in emergency gastrointestinal surgery remains uncertain. Emergency procedures pose unique challenges, including time-critical decision-making, complex anatomy, and limited opportunities for extensive preoperative planning.
AIM
To evaluate the current evidence regarding the feasibility, safety, and clinical outcomes of robotic surgery in the emergency gastrointestinal setting.
METHODS
A systematic literature search of PubMed, Scopus, and the Cochrane Library was performed for studies published through June 15, 2026, following PRISMA guidelines. Eligible studies evaluated robotic-assisted emergency gastrointestinal procedures in adult patients and reported perioperative or clinical outcomes. Study selection, data extraction, and quality assessment were independently performed by two reviewers using validated appraisal tools. Owing to substantial methodological heterogeneity, a descriptive synthesis with pooled weighted means was conducted.
RESULTS
Thirty-two studies met the inclusion criteria, comprising predominantly retrospective cohort studies with additional case series and case reports. Acute cholecystitis represented the most extensively investigated indication (13242 patients), followed by acute appendicitis (475 patients), emergency colorectal surgery (326 patients), abdominal wall hernias (138 patients), perforated peptic ulcer (25 patients), abdominal trauma, and other rare emergency conditions. Across selected patients, robotic surgery demonstrated high technical feasibility, low conversion rates, acceptable operative times, and favorable postoperative recovery. The largest evidence base concerned acute cholecystitis (13242 patients). Among the subset of studies reporting conversion outcomes, conversion to open surgery occurred in 5 of 792 patients (0.6%). However, evidence for other emergency indications remained limited by small sample sizes, retrospective study designs, heterogeneous patient selection, and inconsistent outcome reporting. High acquisition costs, limited platform availability, prolonged setup times, and the need for specialized surgical teams remain important barriers to widespread implementation.
CONCLUSION
Robotic surgery is safe and feasible in carefully selected, hemodynamically stable patients when performed in high-volume centres. However, it does not currently represent a paradigm shift in emergency general surgery compared to standard laparoscopy, primarily due to logistical constraints, prolonged operative times, and higher costs. High-quality prospective multicenter studies and randomized trials are required to define appropriate indications, evaluate cost-effectiveness, and establish the role of robotic technology within modern emergency surgical practice.
Core Tip: Robotic surgery is an emerging option in emergency gastrointestinal surgery, demonstrating feasibility and safety in carefully selected, hemodynamically stable patients. Current evidence supports its use mainly for acute cholecystitis, while data for other indications remain limited. High costs, logistical barriers, and low-quality evidence currently preclude routine adoption.
