Abstract
BACKGROUND: This study aimed to evaluate whether advances in surgical imaging and technology improve clinical outcomes, including operative time, hospital stay, and intraoperative bleeding, across four major hepatopancreatobiliary (HPB) surgeries: the Whipple procedure, hepatectomy, pancreatectomy, and gastrectomy, comparing open laparotomy, laparoscopic, and robotic-assisted (da Vinci) approaches. MATERIAL AND METHODS: A retrospective observational cohort study was conducted using a prospectively maintained database from a university-affiliated minimally invasive surgery center. A total of 486 patients (269 males, 217 females; mean age 57.96 ± 15.71 years) who underwent HPB surgery between July 2015 and September 2019 were included. Surgical method selection was determined by surgeon preference, patient condition, and the chronological introduction of the da Vinci system. One-way analysis of variance was used to compare operative time, hospital stay, and blood loss among the three methods in each surgical category. RESULTS: Significant differences were observed among surgical approaches. In gastrectomy, hospital stay [F(2,158) = 18.66, P < 0.001] and bleeding [F(2,158) = 16.25, P < 0.001] were significantly lower in laparoscopic and robotic groups. In pancreatectomy, operative time [F(2,80) = 3.48, P = 0.04] and bleeding [F(2,80) = 3.16, P = 0.05] showed significant variation, with longer duration in laparoscopy. In the Whipple procedure, only operative time differed [F(1,76) = 26.53, P < 0.001]. In hepatectomy, operative time [F(2,161) = 3.48, P = 0.03], hospital stay [F(2,161) = 11.53, P< 0.001], and bleeding [F(2,161) = 18.29, P < 0.001] were significantly improved in minimally invasive and robotic groups. CONCLUSIONS: Minimally invasive and robotic-assisted surgeries significantly reduced hospital stay and intraoperative bleeding compared with open laparotomy. Operative time varied across procedures, reflecting technical complexity and learning curves. These findings highlight the clinical benefits of image-guided and robotic-assisted techniques in complex abdominal surgery.