**4.3 Cholangiocarcinoma (CAA)**

Minimally Invasive Surgery utilising a robotic approach should theoretically convey the significant advantages to hilar CCA resections given the necessity of extreme precision and micro-anastomosis formation. However CCA resections form less than 10% of robotic liver surgery in the current literature, likely due to the required tertiary level of surgical expertise and robotic technology [22]. As such, the literature exploring oncolocological outcomes is very limited. The largest case series (48 patients) of patients undergoing robotic resections for Type I, II and III CCA, reported successful lymphadenectomy from stations 7,8,9, 12 and 13 and an R0 resection rate of 72.9% [44]. A single study has reported on longer term outcomes following robotic resections and demonstrated significantly higher rates of recurrence and peritoneal disease when compared to a contemporaneous group of open resections in the same centre [45]. As such whilst technically feasible and safe in expert hands, further studies are required to fully elucidate the oncological equivalence of robotic MIS for CCA.

## **4.4 Gallbladder Cancer**

When compared to open radical cholecystectomy, the robotic approach has been shown to result in analogous operative times, blood loss, and length of stay. Specialist centres have also reported equivalent lymph node yields and demonstrated the feasibility of complete robotic lymphadenectomy of stations 8,9 12 and 13 [46–48]. An 100% R0 resection rate has been reported by the only 2 studies that present oncological outcomes [47, 48]. To date, no studies have yet to report on longer term oncological data following robotic radical cholecystectomy.
