Initial experience of benign upper gastrointestinal robotic-assisted surgery: first 200 cases and early postoperative outcomes.

Introduction: Robotic-assisted surgery is an alternative approach to minimally invasive surgery for benign upper gastrointestinal (UGI) conditions and abdominal wall hernia - its application in the United Kingdom is still in the initial phases in many National Health Service (NHS) trusts. We detail the experience of Northumbria Healthcare NHS Foundation Trust in implementing a robotic-assisted surgery service for benign UGI procedures and abdominal wall hernia repair.

Methods: The robotic service for benign UGI was established in the trust in February 2022. All theatre staff received online and simulation training before working in the dedicated robotic surgery theatre. Operative timings, surgical outcome measures and patient outcomes including day-case rates were prospectively recorded and analysed to assess the impact of the introduction of this service.

Results: Between February 2022 and June 2023, some 200 robotic-assisted procedures were performed: cholecystectomy (n = 103), hernia repair (n = 74), anti-reflux surgery (n = 9) and Heller's myotomy (n = 14). Median docking times were recorded: cholecystectomy, 9min (4-94min); hernia repair, 10min (4-50min); anti-reflux surgery, 19min (9-37min); and Heller's myotomy, 15min (6-26min). There were no intraoperative complications. Two patients returned to theatre for bile leak following cholecystectomy, presenting on day 2 and day 9 postoperatively.

Discussion: Robotic-assisted benign UGI surgery can be safely performed in a day-case centre and does not impact day-case rates. There were no theatre delays because of prolonged docking times, even in the initial introductory period. There are higher costs associated with robotic-assisted surgery; however, with time and industry development, these are likely to improve.