# Primarily Gasless Robot-Assisted Cholecystectomy in Dogs: A Cadaveric Feasibility Study

## TL;DR

Researchers tested a new robotic surgery method for removing gallbladders in dogs without using gas, finding it technically feasible in cadavers.

## Contribution

The study introduces a primarily gasless robotic cholecystectomy technique using abdominal wall suspension in a canine cadaveric model.

## Key findings

- The procedure was successfully completed in all five canine cadavers without technical complications.
- Three procedures were performed entirely without CO₂, and two used minimal low-pressure CO₂ as a rescue maneuver.
- Visualization of key anatomical structures was adequate or optimal in all cases.

## Abstract

Gallbladder disorders are increasingly diagnosed in dogs, and many affected patients require surgery to prevent severe complications such as bile leakage or sepsis. Traditionally, gallbladder removal has been performed through an open approach, but this technique is associated with considerable risks and a difficult recovery. In recent years, less invasive procedures, including laparoscopy and robot-assisted surgery, have been explored to improve patient outcomes. In this study, we evaluated a new combination of techniques: performing cholecystectomy with a robotic platform under gasless abdominal suspension. This method avoids the use of carbon dioxide to create working space, which may reduce stress on fragile patients, while robotics appeared to facilitate precise dissection and favorable working conditions in this experimental setting. The procedure was tested successfully in canine cadavers, with consistent access to key anatomical structures, and no technical complications were observed during the procedures in this cadaveric model. These findings support further investigation of this hybrid approach in canine biliary surgery.

Gallbladder disease is a common cause of morbidity in dogs, and cholecystectomy remains the definitive treatment in many cases. Although minimally invasive approaches offer recognized advantages, their adoption is limited by technical complexity and by the physiological effects of carbon dioxide (CO₂) pneumoperitoneum. This cadaveric study evaluated the feasibility of performing primarily gasless robot-assisted cholecystectomy under abdominal wall suspension in five canine cadavers. A normobaric operative field was established using a suspension device combined with the VersiusTM robotic platform. “Primarily gasless” was operationally defined as abdominal wall suspension without continuous pneumoperitoneum, allowing short-duration low-pressure CO₂ insufflation (≤8 mmHg) exclusively as a rescue maneuver when exposure was insufficient. Surgical feasibility was assessed through structured case-level reporting, including docking time, operative time, exposure quality of the hepatocystic triangle (predefined ordinal scale), clipping feasibility, intraoperative events, instrument exchanges, and need for rescue CO₂ insufflation. All procedures were completed in the cadaveric specimens. In three cadavers, the procedure was performed entirely without CO₂. In two cadavers, a single short-duration low-pressure CO₂ insufflation (6–8 mmHg for 3–5 minutes) was applied as a rescue maneuver. Adequate or optimal visualization of the hepatocystic triangle was achieved in all cases, and no intraoperative injuries occurred. These findings support the technical feasibility of a primarily gasless robotic approach in a canine cadaveric model. Controlled in vivo studies are required to evaluate the physiological impact, perioperative outcomes, and translational applicability before clinical implementation.