Objective:To explore and compare the safety and effectiveness of robotic,laparoscopic,and open hepatectomy for hepatolithiasis. Methods:A retrospective analysis of 23 patients with hepatolithiasis who underwent Da Vinci robot-assisted hepatectomy at the Department of Hepatobiliary Surgery,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School from May 2019 to April 2020,was conducted. At the same time,patients who underwent laparoscopic(20 cases)or open hepatectomy(25 cases)for hepatolithiasis were included as controls,in order to make a comparison on the basic clinical information,operation time,blood loss,blood transfusion rate,hepatic port occlusion rate,postoperative hospital stay,postoperative anal exhaust time,postoperative oral intake time,off-bed activity time,visual analogue scale(VAS),liver function,complications,etc. Results:The operation time of the robot group was similar to that of the laparoscopy group,and both were longer than the laparotomy group. There was a long setup time in robot group. When the setup time was excluded,the operative time of the robot group was similar to that of the laparotomy group. As to intraoperative blood loss,the robot group was the least,followed by the laparoscopic group,and the laparotomy group was the most. In terms of total hilar occlusion,the rate of hilar occlusion in the robot group and laparoscopic group was significantly lower than that in the laparotomy group. In addition,robot and laparoscopy hepatectomy were overall superior to open surgery in promoting postoperative recovery,including shorter postoperative hospital stay,faster anal ventilation,earlier oral intake,faster get-out-of-bed,and lower VAS. There was no statistical difference in postoperative liver function and complication rate among the three groups. Conclusion:Robotic and laparoscopic hepatectomies were significantly associated with less intraoperative blood loss,lower rate of total hepatic port occlusion,and better postoperative recovery. Compared with laparoscopic hepatectomy,robotic hepatectomy was associated with significantly less intraoperative blood loss,a shorter operative time,and a shorter postoperative hospital stay.