The development of robotic hepatopancreatobiliary surgery in Singapore: a multi-institutional experience

Abstract

Background: Since the development of robotic technology in the late 1980s, its use has been increasingly adopted in various abdominal surgeries. Improved dexterity, precision, stability and visual magnification of robotic operating systems have been touted as the rationale for their superiority over conventional laparoscopy. These enhanced robotic capabilities are especially relevant in complex hepatopancreatobiliary (HPB) surgeries. To date, Singapore has the largest series of robotic hepatectomy (RH) in the Southeast Asian region. However, no national database for robotic HPB procedures exists and none have studied the trends in its growth and application over the past decade. As such, this nationwide survey aims to evaluate the current status and the development of robotic HPB surgery in Singapore. Methods: A questionnaire was designed to investigate the nature and outcomes of robotic HPB surgeries performed in specialist units nationwide. Participating surgeons were granted access to the questionnaire electronically and were asked to respond appropriately based on their surgical experience between January 2013 and February 2018. Results: A total of 112 robotic HPB surgeries were performed in participating institutions over a 5-year period. There were 47 RH, of which 21 (45%) were performed for hepatocellular carcinomas (HCC). Amongst the 46 robotic pancreatic procedures: 25 distal pancreatectomies, 18 pancreaticoduodenectomies, 2 enucleations and 1 Puestow procedure were performed. Nineteen (17%) of robotic cases were biliary in nature. Rate for conversion to open surgery was 4.5%. Overall major morbidity rate was 10.6%. There was no 90-day mortality reported. Conclusions: There has been a gradual but steady increase in the number of robotic HPB surgeries performed in Singapore. Our national experience demonstrated that the robotic platform is a safe and feasible option that may be utilized with minimal morbidity for complex HPB surgeries.