Initial experience with 72 consecutive robotic-assisted laparoscopic hepatobiliary and pancreatic surgeries at Singapore General Hospital

Abstract

Introduction: Presently, experience with robotic-assisted laparoscopic (RAL) hepatobiliary and pancreatic (HBP) surgery is increasing but remains limited world-wide. In this study, we report our early experience with robotic HBP surgery. Method: Retrospective review of the first 72 consecutive patients who underwent RAL HBP surgery at a single institution between 2013 to 2017. Results: The operations performed were: 30 pancreatic surgeries including 8 pancreatoduodenectomies, 4 extended pancreatectomies with adjacent organ/vascular resection and 10 spleen-saving pancreatectomies; 27 hepatectomies including 9 major hepatectomies and 4 concomitant hilar lymphadenectomies; and 15 biliary procedures including 5 hepaticojejunostomies. There were 2 (2.8%) open conversions due to bleeding during hepatectomy and tumor extending to the celiac axis during pancreatectomy. There were 8 (11.1%) major morbidities (>grade 2) and no 30-day/in-hospital mortality. The major morbidities were all grade 3 including 2 reoperations (grade 3b) for a port-site hernia and a hepaticojejunostomy leak. The median postoperative stay for RAL pancreatic surgery was 6.5 (range, 3-36) days and for RAL hepatectomy was 5 (range, 3-33) days. Conclusions: Our initial experience confirms the feasibility and safety of RAL HPB surgery even for complex procedures such as pancreatoduodenectomies, extended pancreatectomies, major hepatectomies and bilio-enteric anastomoses.