SHOULD OPEN CHOLECYSTECTOMY REMAIN IN SURGICAL TRAINING? A NARRATIVE REVIEW IN THE ERA OF ADVANCED LAPAROSCOPY AND ROBOTICS

Abstract

Gallstone disease remains common worldwide, and cholecystectomy continues to be a core procedure in general surgery. Although laparoscopic cholecystectomy is now the standard approach and robotic surgery is increasingly adopted, open cholecystectomy remains relevant in selected difficult cases, conversion, and complication management. Declining trainee exposure to open surgery has raised concern about whether this skill should still be preserved in surgical education. This narrative review evaluated whether open cholecystectomy should remain part of the surgical training curriculum in the era of advanced laparoscopy and robotics. This study was conducted as a narrative review. Relevant English-language literature was searched in PubMed, Scopus, and Google Scholar from inception to March 2026. Guidelines, reviews, cohort studies, surveys, and educational papers were selected based on relevance to open cholecystectomy, difficult gallbladder surgery, conversion, bailout strategies, robotic surgery, and surgical training. Findings were synthesized thematically without meta-analysis. The reviewed literature showed that open cholecystectomy has shifted from a routine operation to a selective safety procedure. It remains important in severe inflammation, frozen Calot’s triangle, dense adhesions, bleeding, suspected bile duct injury, and resource-limited settings. Studies also showed declining trainee exposure and confidence in open biliary surgery. This relevance persists despite the growing adoption of robotic surgery. Open cholecystectomy should be retained in surgical training as a selective but essential competency. Although no longer a routine procedure for all trainees, it remains important for safe conversion, for managing difficult biliary anatomy and complications, and for maintaining context-appropriate operative preparedness.

Keywords: Open cholecystectomy, Surgical training, Laparoscopic cholecystectomy, Robotic surgery, and Surgical curriculum.