Evolution of Robotic Surgery in Hepato-Pancreato-Biliary Practice: A Critical Evidence-Based Review

INTRODUCTION: Robotic surgery has progressively expanded within hepato-pancreato-biliary (HPB) practice, aiming to overcome the technical limitations of conventional laparoscopy in complex resections and reconstructions. Over the past 2 decades, its role has evolved from feasibility reports to comparative analyses, consensus statements, and randomized controlled trials. However, evidence remains heterogeneous across liver, pancreas, and biliary domains, and the clinical impact of robotic surgery appears to be procedure-specific rather than universal. This study aimed to provide an evidence-based narrative review of the evolution of robotic HPB surgery, with emphasis on perioperative outcomes, oncologic safety, technical indications, and current limitations. METHODS: A narrative literature review was conducted using PubMed, Embase, and Scopus databases, including studies published between January 2000 and February 2026. Search terms included combinations of "robotic surgery", "hepatectomy", "liver resection", "pancreatic surgery", "pancreatoduodenectomy", "distal pancreatectomy", "biliary surgery", "cholangiocarcinoma", and "hepaticojejunostomy". Original studies, systematic reviews, meta-analyses, randomized trials, and consensus guidelines were included. Data were synthesized qualitatively, incorporating quantitative outcomes when available, including operative time, estimated blood loss, conversion rates, complications, oncologic outcomes, and learning-curve metrics. RESULTS: Robotic liver surgery has demonstrated comparable perioperative and oncologic outcomes to laparoscopic and open approaches, with lower conversion rates, reduced blood loss, and shorter operative time in selected high-difficulty resections. Robotic pancreatic surgery has expanded with increasing standardization. Robotic distal pancreatectomy shows consistent advantages compared to laparoscopic distal pancreatectomy with comparable overall morbidity and shorter postoperative hospital stay. Robotic pancreatoduodenectomy has reached randomized evaluation with comparable overall morbidity and shorter postoperative recovery when performed in high-volume centers by experienced surgeons. Robotic biliary surgery remains less standardized and is concentrated in specialized centers; however, recent comparative studies suggest feasibility in bile duct reconstruction and potential advantages in lymphadenectomy. Across all domains, outcomes are strongly influenced by institutional expertise, structured training, and case selection. CONCLUSIONS: Robotic HPB surgery has emerged as a key advancement in minimally invasive surgery, with its greatest value in complexity-dependent, technically demanding procedures. Although current evidence supports its safety and oncologic adequacy in selected patients, outcomes remain highly contingent on case selection, surgical expertise, and structured implementation. Future progress will depend on defining optimal indications rather than feasibility, supported by standardized reporting, cost-effectiveness analyses, and robust long-term oncologic data.