Outcomes of Robotic Surgery in a Single-institution, High-volume Hepatobiliary Oncology Unit

Abstract

Hepatobiliary surgery has traditionally been performed via an open approach. With the advent of robotic surgery, the minimal access approach in hepatobiliary oncology has gained impetus due to its technical superiority and favorable learning curve over laparoscopy. We present our experience with the Da Vinci Xi system in hepatobiliary oncology. This is a retrospective study from a prospectively maintained database. All patients who underwent surgery between June 2015 and July 2023 for suspected gallbladder cancer and primary or metastatic liver tumors were included. After excluding all inoperables and conversions, a total of 92 patients were included for analysis. There was a conversion rate of 15.6% (17 of 109 patients). Sixty-four (69.6%) patients underwent surgery for gallbladder-related pathologies that included 39 (60.9%) radical cholecystectomies, 24 (37.5%) simple cholecystectomies, and 1 (0.01%) revision cholecystectomy. Twenty-eight patients underwent surgeries for primary or metastatic liver tumors, which included 25 (92.9%) minor and 2 (7.1%) major hepatectomies. Significant morbidity (Clavien-Dindo grade III or more) was seen in 8 (8.6%). There was no postoperative mortality. In the group with gallbladder cancer, the median lymph nodal yield was 7 (2-22) in patients who underwent lymph nodal dissection. The median follow-up was 63.9 (0.49-100.67) (IQR = 37.76) months. The 5-year OS and DFS were 76.4 and 71.3%, respectively. Robotic hepatobiliary surgery is feasible and can be performed safely after adequate training. Patient selection is of utmost importance and is the key to establishing a robust robotic hepatobiliary oncosurgery program.

Keywords: Cholecystectomy; Hepatectomy; Metastatectomy; Radical; Robotic surgery.

Fig. 1

A, B Robotic port position (R1 to R4, 8 mm) with assistant ports (AP, 12 mm)

Fig. 2

A Port positions of robotic (8 mm) and assistant ports (12 mm). B Laser pointer in the overhead boom was used to center the boom over the camera port (R2)

Fig. 3

Targeting of operative anatomy over the liver (in this case planned for a left lateral sectionectomy)

Fig. 4

Tumor identification using ICG and resection marking, taking an adequate margin

Fig. 5

Kaplan–Meir curves depicting (A) Overall Survival (OS) and (B) Disease Free Survival (DFS)