Robotic hepatopancreatobiliary surgery using the Toumai® system: initial experience and technical considerations from...

Robotic-assisted hepatopancreatobiliary (HPB) surgery is increasingly adopted in high-volume centers. This study evaluated the feasibility, safety, and technical characteristics of the Toumai® robotic system in HPB surgery. We retrospectively analyzed 160 consecutive patients who underwent HBP surgery using the Toumai® system at the Chinese People's Liberation Army General Hospital between November 2024 and June 2025. Procedures included liver resection (92 cases: 32 lobectomies/segmentectomies and 60 local resections), pancreatic surgery (23 cases: 2 pancreaticoduodenectomies, 9 distal pancreatectomies, 11 tumor resections, 1 pancreatic duct incision and pancreaticojejunostomy), and biliary surgery (37 cases: 3 radical resections for hilar cholangiocarcinoma, 23 biliary explorations and stone removals, 6 gallbladder cancer resections, 3 choledochojejunostomies, and 2 cholecystectomies). Of the cohort, 46 patients (28.8%) had prior abdominal surgery. Conversion to open surgery occurred in 3 cases (1.9%). Postoperatively, one patient developed pancreatic fistula managed with percutaneous drainage; no other Clavien-Dindo III-IV complications or in-hospital deaths were observed. Median postoperative length of stay was 5 days (range, 1-27 days). Toumai® robotic-assisted surgery demonstrates preliminary feasibility and safety across a spectrum of HPB procedures. With technical refinements and device iterations, broader adoption may enhance the accessibility and affordability of robotic surgery in resource-variable settings.​.