Abstract:Background and Aims Complex biliary stones are often accompanied by hilar adhesions, distorted anatomy, biliary variations, or biliary-enteric fistulas. Conventional laparoscopic surgery is limited in such settings, with high conversion and complication rates. Robotic surgical systems provide high-definition 3D vision and enhanced dexterity, potentially improving surgical outcomes. This study compared the clinical efficacy of robotic vs. laparoscopic surgery for complex biliary stones.Methods A retrospective analysis was performed on 145 patients with complex biliary stones who underwent minimally invasive surgery at Fujian Provincial Hospital, Fuzhou University, from January 2023 to January 2025. Patients were divided into a robotic group (n=62) and a laparoscopic group (n=83). Intraoperative outcomes, postoperative complications, and recovery parameters were compared. Stone recurrence was assessed during follow-up.Results Baseline characteristics were comparable between groups (all P>0.05). The conversion rate was 0 in the robotic group vs. 7.2% in the laparoscopic group (P=0.038). The postoperative complication rate was significantly lower in the robotic group (1.6% vs. 10.7%, P=0.044). Time to first oral intake, first flatus, and postoperative hospital stay were all shorter in the robotic group (all P<0.05). No stone recurrence was observed in either group during follow-up until June 2025.Conclusion Robotic surgery is a safe and feasible approach for complex biliary stones, offering reduced conversion and complication rates and faster recovery compared with laparoscopy. It holds promise for wider clinical application in complex biliary disease.