Future directions of robotic surgery in the Hepatobiliary and Pancreatic field including new robotic platforms

In this presentation, we report the current status of robotic-assisted surgery in the hepatobiliary and pancreatic (HBP) field at our institution, summarize its advantages separately for liver and pancreatic resections, and discuss future directions, including new robotic platforms.
As of March 2025, we have performed 287 robotic-assisted liver resections and 254 robotic-assisted pancreatic resections. We will present the short-term outcomes of each and elaborate on the rationale behind the standardization of robotic liver and pancreatic resections (specifically pancreaticoduodenectomy) at our institution.
Liver resection:
1. Establishment of port placement strategies for right and left lobes, with the use of assistant and intercostal ports
2. Peel-off and sweep technique using double bipolar forceps
3. Parenchymal transection performed by the assistant using CUSA
Pancreatic resection:
1. Selection of approach to the uncinate process
2. Dissection of the pancreatic head plexus using the hanging maneuver
3. Pancreatojejunostomy using the modified Blumgart technique
4. A structured educational framework for robotic pancreatic resection through task delegation
The standardization of robotic-assisted surgery in the HBP field is expected to improve short-term outcomes by reducing bile leakage in liver resections and pancreatic fistulas in pancreaticoduodenectomy. Moreover, even in the HBP domain, new robotic platforms can be safely implemented. At this stage, careful case selection based on the specific characteristics of each system is considered essential.