Trends in robotic upper gastrointestinal and hepatopancreatobiliary surgery in Australia: a private sector-based...

Robotic surgery is increasingly adopted across surgical specialties because of advantages in visualisation, dexterity, and ergonomics. However, data on its use in upper gastrointestinal (UGI) and hepatopancreatobiliary (HPB) surgery in Australia remain limited. This study characterises trends in robotic UGI and HPB surgery in Australia using data from the da Vinci System and Medicare Benefits Schedule (MBS) Item Reports website. Robotic procedure counts between 2013 and 2023 were obtained from Device Technologies Australia, local distributor of the da Vinci System by Intuitive Surgical in Australia. Corresponding MBS item numbers were used to determine UGI and HPB procedure volumes. Descriptive statistics, Poisson regression, and linear models were used to analyse trends over time. Robotic UGI and HPB surgery volume increased on average by 33% annually (95% CI 31%, 35%) over the study period, adjusted for surgery type. The proportion of MBS-claimed UGI and HPB procedures performed robotically increased on average by 0.16% (95% CI 0.12%, 0.20%) and 0.11% (95% CI 0.07%, 0.15%) per year, respectively. Cholecystectomy was the most common HPB procedure performed robotically but accounted for only 0.6% of MBS-claimed procedures. A considerable proportion of MBS-claimed left-sided pancreatectomies (34.4%) and pancreatoduodenectomies (18.1%) were performed robotically in 2023. Robotic bariatric procedures were the most commonly performed UGI procedure, although procedure counts plateaued after 2022. Robotic surgery for UGI and HPB procedures increased significantly over the study period. Notably, there has been a recent rise in the adoption of robotic approaches for complex non-bariatric procedures, particularly pancreatic surgery.