Outcomes of Robotic surgery in a single institution high volume hepatobiliary oncology unit

Introduction: Hepatobiliary surgery has traditionally been performed via an open approach. With the advent of robotic surgery, minimal access approach in hepatobiliary oncology has gained impetus due to it technical superiority and favorable learning curve over laparoscopy. We present our experience of Da Vinci Xi system in hepatobiliary oncology Materials: and methods This is a retrospective study from a prospectively maintained database. All patients who underwent surgery between June 2015 till July 2023 for suspected gallbladder cancer and primary or metastatic liver tumors were included. Results: A total of 113 patients were included, of which 2 patients were declared inoperable in view of peritoneal metastasis. Seventy-five patients underwent surgery for gallbladder related pathologies that included 47(42.3%) radical cholecystectomies, 27(24.3%) simple cholecystectomies and 1(0.9%) revision cholecystectomy. 36 patients underwent surgeries for primary or metastatic liver tumors which included 26(23.4%) left lateral hepatectomy, 6 (5.4%) non-anatomical resection, 2(1.8%) right hepatectomy, 1(0.9%) robotic assisted right hepatectomy and 1(0.9%) left hepatectomy. Conversion to open was required in 17 (15.3%) patients. Median blood loss was 250 (10-3500) ml and median hospital stay was 4 (1-25) days. Median lymph nodal yield was 8(2-22) in patients who underwent lymph nodal dissection for gallbladder cancer. Eleven (9.9%) patients had significant morbidity (Clavien Dindo Grade III or more). There was one post operative mortality (0.9%). Conclusion: 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.