HPB P22 The stepwise implementation of robotic HPB program in a single UK centre; a continuum of practice


 
 
 Since the first documented use of a robot for surgery in 1985, there has been a rapid global adoption of this technology. Hepatobiliary and pancreatic (HPB) surgery centres worldwide are increasingly sharing their robotic experiences, testing its potential to become a new standard for surgery. We are among the small number of known robotic HPB programs in the UK and here describe our stepwise implementation and share our learning curve.
 
 
 
 We performed a retrospective review of our prospective database of robotic HPB surgeries carried out by two surgeons from the start of the program in September 2021 up to May 2022. Metrics analysed included surgery console times and 30-day patient perioperative outcomes. Results are shown as mean +/- std unless stated otherwise.
 
 
 
 There were 53 cases performed in 8 months. For all cases mean patient age was 58 years (range 26–82 years), BMI was 27.3 ± 4.3 Kg/m2 and docking time was 3.20 ± 0.97 minutes.
 There were 2 defined performance phases; early practice which included the following cases - marsupialisation of liver cysts (n = 7), cholecystectomies (n = 22) and radical cholecystectomies (n = 5). Intermediate practice followed when no decrease in console time was observed, and patients’ safety was maintained, and cases included liver wedge resections (n = 9) and distal pancreatectomies (n = 10).
 Mean console time for marsupialisation of liver cysts was 39 ± 0.01 minutes, cholecystectomies 44 ± 0.01 minutes, radical cholecystectomies 109 ± 0.01 minutes, liver wedge resections 87 ± 0.04 minutes and distal pancreatectomies 153 ± 0.03 minutes. Length of stay for distal pancreatectomies was 6.8 ± 2.2 days and liver wedge resections 2.3 ± 1.1 days.
 There was 1 conversion to open, 1 reoperation and 3 readmissions. There were 9 postoperative complications Clavien-Dindo grade I (n=1), grade II (n=5), grade IIIa (n= 2) and grade IIIb (n= 1). The rate of pancreatic fistula (International Study Group of Pancreatic Fistula classification grade B) was 3% (n=3), there were no 30-day mortalities.
 
 
 
 Our outcomes show acceptable safety metrics during the implementation our HPB robotic program. Only after evaluating our learning curve and patients’ outcomes in each performance phase do we progress to the next phase, which for our program is the complex phase and includes pancreaticoduodenectomy and more complex liver resections.
