This paper introduces the latest technology developments in the field of adherent cell culturing. This highly multidisciplinary field is first matched with its numerous applications, such as the production of therapeutics, drug development, and toxicology. Further, the paper focuses on perfusion cell culturing systems intended for difficult-to-culture cells (such as primary and stem cells) and high-content screening (HCS) purposes. Parts of such advanced adherent cell culturing systems are presented including the open questions related to them. The system constituents are addressed in terms of cells and tissue models, cell culturing media, culturing vessels, actuation instrumentation, measurement instrumentation, and control. Finally, the paper outlines future directions for laboratory automation with regard to cultivation of primary and stem cells.