Implementation of a robotic hepato-pancreato-biliary surgery program: a swedish referral center's experience

Robotic-assisted surgery has been recognized for enhancing the feasibility of minimally invasive procedures, particularly in high-complexity fields like hepato-pancreato-biliary (HPB) surgery. This study aims to describe the implementation and development of a robotic HPB surgery program at a Swedish referral center, during a structured transition from mostly open surgery, as well as evaluating perioperative outcomes. A retrospective observational study at Karolinska University Hospital (September 2020-July 2024) included patients undergoing robotic HPB resections. Data on demographics, procedure types, intraoperative metrics, and outcomes were collected. Program implementation followed a stepwise approach. A total of 495 robotic resections were performed by three generations of surgeons, including 235 liver, 208 pancreatic, and 52 biliary resections. The overall conversion rate to open surgery was 7.7%. Major complications were observed in 10.9% of cases, with a mortality rate of 0.8%. Exposure and training improved outcomes over time, indicating the value of a structured implementation approach and a stepwise introduction of new surgeons into the robotic program. The transition to robotic HPB surgery requires a well-organized approach that includes thorough training and close collaboration within a multidisciplinary team. The program focused on helping junior surgeons develop their skills, starting with simpler procedures to reduce risks and ensure patient safety. After 8 semesters, minimally invasive HPB surgeries have increased from 15 to 41%. Results show that the program is safe and effective, highlighting the importance of institutional support, teamwork, and strategic planning in building a successful and lasting robotic surgery program.