Transitioning to the robotic era for perihilar cholangiocarcinoma: initial implementation and outcomes in a single center.

BACKGROUND: Robotic surgery for perihilar cholangiocarcinoma (pCCA) remains controversial owing to concerns regarding its technical feasibility and oncological adequacy. This study evaluated the early clinical outcomes of robotic surgery for pCCA during the institutional transition from open to robotic surgery. METHODS: We retrospectively analyzed 76 patients who underwent curative-intent resection for pCCA between January 2013 and January 2026. Of these patients, 66 underwent open surgery and 10 underwent robotic resection. Robotic surgery was introduced following extensive institutional experience with open and complex robotic hepatobiliary procedures. Perioperative outcomes, oncological parameters, and textbook outcome (TO) achievement were compared between the groups. RESULTS: R0 resection was achieved in 90.0% of robotic cases and 78.8% of open cases, and lymph node retrieval did not differ significantly between the groups. A higher proportion of patients in the robotic group attained TO (50.0% vs. 36.3%), although this trend did not reach statistical significance (P = 0.415). Major complications occurred in 30.0% of robotic cases and 25.7% of open cases (P = 0.780), and no 90-day mortality occurred in the robotic group. The length of hospital stay was similar despite the minimally invasive approach. CONCLUSIONS: Robotic surgery for pCCA is feasible and can be safely implemented following institutional validation in highly selected patients during the early implementation phase. While our early experience demonstrates acceptable perioperative outcomes, additional studies with larger cohorts and long-term follow-up are required to further evaluate the clinical utility and outcomes of robotic surgery and to define its role in pCCA.