Adoption of Robotic Liver, Pancreatic and Biliary Surgery in Singapore: A Single Institution Experience with Its First 100 Consecutive Cases

Abstract

Introduction: Presently, robotic hepatopancreatobiliary surgery (RHPBS) is increasingly adopted worldwide. This study reports our experience with the first 100 consecutive cases of RHPBS in Singapore. Methods: Retrospective review of a single-institution prospective database of the first 100 consecutive RHPBS performed over 6 years from February 2013 to February 2019. Eighty-six cases were performed by a single surgeon. Results: The 100 consecutive cases included 24 isolated liver resections, 48 pancreatic surgeries (including 2 bile duct resections) and 28 biliary surgeries (including 8 with concomitant liver resections). They included 10 major hepatectomies, 15 pancreaticoduodenectomies, 6 radical resections for gallbladder carcinoma and 8 hepaticojejunostomies. The median operation time was 383 minutes, with interquartile range (IQR) of 258 minutes and there were 2 open conversions. The median blood loss was 200ml (IQR 350ml) and 15 patients required intra-operative blood transfusion. There were no post-operative 90-day nor in-hospital mortalities but 5 patients experienced major (> grade 3a) morbidities. The median post-operative stay was 6 days (IQR 5 days) and there were 12 post-operative 30-day readmissions. Comparison between the first 50 and the subsequent 50 patients demonstrated a significant reduction in blood loss, significantly lower proportion of malignant indications, and a decreasing frequency in liver resections performed. Conclusion: Our experience with the first 100 consecutive cases of RHPBS confirms its feasibility and safety when performed by experienced laparoscopic hepatopancreatobiliary surgeons. It can be performed for even highly complicated major hepatopancreatobiliary surgery with a low open conversion rate. Keywords: Biliary surgery, hepaticojejunostomy, liver resection, pancreas, pancreaticoduodenectomy

Propensity Score–Matched Analysis Comparing Robotic and Laparoscopic Right and Extended Right Hepatectomy

“…It may also enhance the dissection and control of short hepatic veins in the hepatocaval region and allow easier suture plication of bleeders during parenchymal The main drawbacks associated with robotic surgery compared with laparoscopy include the limited access to the platform and high costs of the procedure. 34,35 Results from this multicenter study found that robotic approach was associated with a shorter hospital stay without increase in operating time and other morbidities. It suggests that hospitalization costs may be possibly saved with robotic approach if the cost for robotic instruments can also be reduced.…”

“…The robotic approach has several potential advantages over the laparoscopic approach for RH/ERH. [34][35][36][37][38] The 7 degrees of freedom of the robotic system may theoretically overcome the problems of difficult access by rigid laparoscopic instruments. Robotic instruments may also facilitate the fine extrahepatic hilar dissection of individual hepatic artery and portal vein in RH/ERH.…”

“…The robotic approach has several potential advantages over the laparoscopic approach for RH/ERH . The 7 degrees of freedom of the robotic system may theoretically overcome the problems of difficult access by rigid laparoscopic instruments.…”

Evolution and trends in the adoption of laparoscopic liver resection in Singapore: Analysis of 300 cases

“…Thirdly, during the study period, the surgeon had also gained further laparoscopic experience by performing other abdominal procedures such as pancreatectomies, gastric resections and major biliary procedures. 7,36 Fourthly, as the surgeon was practising in a high-volume centre, he had gained further concomitant experience with LLR by tutoring and assisting other surgeons who were adopting LLR during the study period. Finally, it is also important to add that the learning curve of a surgeon exposed to LLR, such as an LLR fellowship-trained surgeon, would likely be shorter and less steep than the current reported experience.…”

“…1 However, although the first laparoscopic liver resections (LLR) were reported in the early 1990s, 2,3 widespread adoption of LLR was met with initial skepticism due to technical concerns and the fear of uncontrollable intraoperative bleeding. [4][5][6][7] Furthermore, concerns were raised regarding the use of LLR for hepatic malignancies due to the potential for compromise in resection margins and oncological outcomes. 8,9 Nonetheless, despite these initial hesitancies, the adoption of LLR has rapidly increased over the past decade 10 and LLR has become the standard approach today in many specialised liver centres, especially for minor liver resections for tumours in anterolateral…”