Robotic and laparoscopic pancreatic and hepatobiliary surgery Reducing the learning curve

This thesis describes a nationwide approach to reduce the learning curve for minimally invasive pancreatic and hepatobiliary surgery, including randomized controlled trials to assess the use of 3D visions, articulating surgical instruments and prospective trials to assess learning curve outcomes and compare outcomes to the conventional (open) approach.
Robotic surgery and 3D-laparoscopy offer potential benefits for pancreatico-, hepaticojejunostomy, and gastric anastomoses. However, more studies are needed to confirm these benefits in real-world clinical settings. Minimally invasive liver surgery (MILS) has gained traction in Europe, with laparoscopy being the most common approach. RLS, or robotic liver surgery, has also seen increasing adoption, particularly in the Netherlands. However, the widespread implementation of RLS is hindered by the lack of dedicated training programs and volume mismatch. While RLS has promising outcomes, further studies and structured training programs are essential to optimize its utilization.
The Dutch multicenter robotic pancreatoduodenectomy training program demonstrated feasibility and potential protective effects for patients. Sufficient surgical volume correlated with shorter learning curves, while prior laparoscopic experience accelerated the learning process. However, significant differences in major morbidity and mortality were not observed compared with open pancreatoduodenectomy. The length of hospital stay was one day shorter after robotic surgery, supporting the minimally invasive approach for uncomplicated cases. Video grading of anastomoses using OSATS helps identify learning curves, predict complications, and improve training in minimally invasive HPB (hepatopancreatobiliary) surgery.
In conclusion, robotic surgery and 3D-laparoscopy hold potential advantages, but further research and optimal training programs are crucial to fully assess their benefits and ensure patient safety.