My prospect on minimally invasive HBP surgery

According to the National Clinical Database, operative mortality from HBP surgery has decreased recently. However, over 1% of patients die after liver resection, and around 2% of patients die after pancreatic resection. Will these operative mortalities become lower after minimally invasive HBP surgery? We don't know the answer yet, but I am sure they will from my gut feeling. I started laparoscopic liver resection (LLR) in 1995 and tried to solve the problems that I had then by applying robotic assistance to improve the poor ergonomics. I performed the world's first robotic liver resection (RLR) in 2001, but robotic assistance did not give many benefits to LLR. Even from that time, I believe robotic pancreatoduodenectomy (RPD) can be possible and will become a standard of care in the future. Then, I gave up continuing RLR and focused on improving the quality of parenchymal transection in LLR.
I chaired the international consensus conference on LLR twice in 2014, Morioka, and in 2021, Tokyo. We concluded the short-term benefits of LLR over open liver resection (OLR) and defined limited anatomic resection with the parenchymal sparing concept. The liver is an anatomic organ, but the problem is that these anatomical structures are hidden inside the parenchyma. I believe any surgery should be performed anatomically, respecting blood circulation in the organ. Now we can perform anatomic liver resection guided by indocyanine green (ICG) negative staining. Inter-segmental/sectional plane is visualized by ICG negative staining. I believe this is the way to go for LLR and RLR. We restarted RLR this year and are now evaluating its merits over LLR.
We started RPD in February 2017 and accumulated over 60 cases with acceptable short-term outcomes. Our rationale for starting RPD was possible less pancreatic fistula (PF) with precise pancreaticojejunostomy. So far, our PF rate is around 5%, but we have to wait to conclude RPD results in less PF. Before we started RPD, we had to give up laparoscopic PD because one out of three cases developed severe PF. For us, the only way to perform minimally invasive PD is RPD. I believe RPD will soon become standard care, but RLR needs more time to spread because of its uncertainty of superiority over LLR.