Robotic surgery in emergency abdominal surgery: current applications and future directions

Emergency abdominal surgery carries substantial morbidity, mortality, and healthcare utilisation. While laparoscopy is now standard for many acute abdominal conditions, the role of robotic-assisted surgery remains debated in emergency settings due to concerns regarding time to source control, cost, system access, and staffing. Across indications, robotic emergency surgery appears feasible and generally safe in carefully selected, haemodynamically stable patients managed in experienced centres. Short-term clinical outcomes are broadly comparable to laparoscopy, with the most consistent potential advantage being reduced conversion-to-open rates in technically challenging cases at the expense of longer operative times in several cohorts. For common emergencies such as acute cholecystitis and appendicitis, evidence does not demonstrate clear superiority over laparoscopy, and safety signals during adoption underscore the need for governance and audit. Economic analyses consistently report higher costs for robotic emergency cases that are not reliably offset by shorter length of stay or reduced complications. Robotic-assisted surgery should therefore be considered a selective adjunct in emergency abdominal surgery, guided by patient stability, procedural complexity, surgeon expertise, and institutional resources.