Challenges and catalysators in building a robotic HPB program: the experience of a tertiary cancer center

Successful implementation of a robotic hepato-pancreato-biliary (HPB) program requires multiple elements and resources. Robotic HPB surgery has been performed at our center for over 15 years. We discuss the impact of different factors on our robotic HPB program's development. Adult patients undergoing the following procedures between 2009 and 2022 were identified: pancreatectomy, hepatectomy and hepatic artery infusion pump (HAIP) placement. A total of 573 procedures were included; distal pancreatectomy (26.8%), HAIP placement (27.2%), hepatectomy (39.4%) and pancreatoduodenectomy (6.5%). Three phases in the program's evolution were recognized; Initial Experience (2009-2014), Stabilization (2015-2019) and Expansion (2020-2022). During the latter, a total of 280 (48%) robotic HPB procedures were performed, increasing the average number of procedures per year from 27 to 93. There was a non significant increase in major complications with program evolution (13.3%, 22.8%, 22.3%, p = 0.08). A critical mass of surgeons and creating a learning ecosystem played a significant role in the program's evolution, along with the support of other experienced HPB surgeons, dedicated OR personnel, technological advances and expanding surgical indications. These elements should be considered when planning and building a robotic HPB program.