Robotic systems, artificial intelligence (AI), and augmented reality (AR) are increasingly reshaping plastic and reconstructive surgery by enhancing precision, reproducibility, and surgical decision-making. While conventional robotic platforms such as the Da Vinci system have demonstrated clear benefits in minimally invasive surgery, their application in microsurgery has remained limited due to instrument size and insufficient submillimetric control. Recently developed microsurgical platforms, including the Symani® Surgical System (Medical Microinstruments, Pisa, Italy) and the MUSA® system (MicroSure B.V., Eindhoven, The Netherlands), address these limitations through motion scaling, tremor suppression, and compatibility with open-field reconstruction. Early clinical studies report successful lymphatic and microvascular anastomoses, improved ergonomics, and reduced surgeon fatigue, marking a significant step toward routine robot-assisted microsurgery. In parallel, advances in AI and machine learning enable data-driven surgical planning, perforator mapping, flap selection, complication prediction, and automated documentation. Large language models further support clinical workflows through structured documentation and patient communication, while AR and virtual reality enhance anatomical orientation, intraoperative navigation, and surgical training. Despite these advances, challenges remain, including heterogeneous data quality, algorithmic bias, limited interoperability, and evolving regulatory frameworks. Addressing these issues is essential to ensure safe and equitable implementation. Future developments are expected to converge into an integrated, AI-augmented surgical ecosystem combining preoperative planning, robotic execution, and outcome-based learning. Rather than replacing surgical expertise, these technologies aim to augment human skill and support a more personalized and efficient reconstructive practice.

Background/Objectives: Biliary tract cancer (BTC) comprises anatomically and molecularly distinct diseases, yet real-world data integrating molecular testing with clinicopathological characteristics and outcomes after resection remain limited. We evaluated clinical and molecular heterogeneity across the major BTC subtypes in a contemporary surgical cohort. Methods: Consecutive adults undergoing curative-intent resection for intrahepatic (iCCA), perihilar (pCCA), distal (dCCA) cholangiocarcinoma, or gallbladder cancer (GBC) at a single Vienna center between 2019 and 2025 were analyzed at the patient level using the first qualifying resection as the index procedure. Molecular testing (52-gene Oncomine Focus; 50-gene Precision/Genexus), perioperative and pathological outcomes, recurrence, and overall survival (OS) were assessed. Results: The cohort included 145 patients (73 iCCA, 24 pCCA, 22 dCCA, 26 GBC). Molecular profiling was available in 103 patients (71%). IDH1/2 and FGFR2 alterations were confined to iCCA, whereas KRAS alterations were most frequent in pCCA and dCCA. Major morbidity occurred in 54/145 patients (37%) and was highest in pCCA (16/24, 67%); 17 Grade V events were documented. Median OS was 40.0 months and did not differ significantly across anatomical subtypes (log-rank p = 0.250). Cumulative incidence of recurrence likewise did not differ significantly across subtypes when death without prior recurrence was treated as a competing event (Gray’s test p = 0.163). Conclusions: The principal contribution of this real-world cohort is the integration of routine molecular testing with surgical, pathological, treatment, perioperative, and longitudinal outcome data across resected BTC subtypes. Assay coverage and testing selection must be considered when interpreting molecular findings generated in routine practice.