Laparotomy, Laparoscopy, da Vinci System

• The study was conducted with the assistance of Chung Shan Medical University's MIS (Minimally Invasive Surgery) Center, which included the general surgery team with extensive experience in open surgery, laparoscopic surgery, and Da Vinci surgery. The study collected a five-year dataset of patients from July 2015 to September 2019 at Chung Shan Medical University Hospital. A total of 486 patients (mean age = 57.96 ± 15.71 years) were enrolled in this study, comprising 269 males (mean age = 58.39 ± 15.49 years) and 217 female patients (mean age = 57.48 ± 16.00 years). All patients underwent robotic surgery for gastrectomy, liver resection, or pancreatectomy during the study period.
• Regardless of the surgical methods (laparotomy, laparoscopy, or da Vinci system), the first step after the patient enters the operating room is always anesthesia. After administering anesthesia, the following different operation procedures result in different viewing images. During laparotomy, the surgeon opens the patient's body directly and operates with the naked eye. One disadvantage of laparotomy is that large wounds require more time to recover. In 2-dimensional (2D) image laparoscopy, a 2D screen shows an image that allows the surgeon to perform stereoscopic surgery. Although most surgical processes are similar between laparoscopy and robotic surgery, the imaging system has undergone significant improvements in robotic surgery. In surgery using the da Vinci system, an endoscope that captures high-definition 3-dimensional (3D) images from the surgical site is utilized. Images are processed using a video processor in the vision cart and displayed on a 3D viewer and touchscreen.
• Statistical analysis was performed using SPSS version 20.0. One-way ANOVA was used to analyze two or more variables, and statistical significance was set at p < 0.05. In this study, we analyzed the relationship between three different groups of surgical methods and three perioperative outcomes (operative time, hospital stay, and bleeding) in the context of four Hepato-Pancreato-Biliary Surgery (HPB) surgeries.

Inclusion criteria

• Adult patients (age ≥ 18 years)
• Underwent one of the following surgeries: gastrectomy, liver resection, or pancreatectomy
• Received surgery at Chung Shan Medical University Hospital between July 2015 and September 2019
• Surgery performed by the general surgery team with experience in open, laparoscopic, and robotic (da Vinci) surgery
• Surgical method included one of the following: open surgery (laparotomy), laparoscopic surgery, or robotic (da Vinci) surgery

Exclusion criteria

• Patients who underwent surgeries outside the specified types (i.e., not gastrectomy, liver resection, or pancreatectomy)
• Patients with incomplete or missing perioperative data (e.g., operative time, blood loss, or hospital stay)
• Patients who underwent combined or staged surgical procedures unrelated to the HPB domain