Most Searched
Originally published October 8, 2026
Last updated October 8, 2026
Reading Time: 4 minutes
Search more articles
News & Magazine
Topics
The question of how to best manage complex hepatobiliary and pancreatic (HPB) malignancies often hinges on balancing oncologic efficacy with patient recovery. While open surgery remains the preferred method for many of these complex cases, the landscape is shifting. Robotic-assisted surgery is enabling minimally invasive approaches to some of the most challenging abdominal procedures, offering patients the potential for faster recovery without compromising outcomes.
Gautam K. Malhotra, MD, PhD, a hepatobiliary and pancreatic surgical oncologist with the USC Pancreatic and Hepatobiliary Disease Center, part of Keck Medicine of USC, is at the forefront of this evolution. With fellowship training in complex surgical oncology and a special interest in minimally invasive techniques, Malhotra brings advanced robotic expertise to patients with liver, pancreas and biliary tract cancers.
Robotic surgery has followed an adoption curve similar to laparoscopy — starting with simpler procedures like removing gallbladders before advancing to more complex applications. “Hepatobiliary is probably some of the most complex abdominal surgery that we do,” Malhotra explains. “It has only recently become more possible with better technique and newer technologies to use the robotic platform for these very complex surgeries.”
Among the most technically demanding procedures in general surgery is the pancreaticoduodenectomy, or Whipple procedure — which involves removal of the pancreatic head, duodenum, portions of the bile duct and associated structures, followed by complex reconstruction with (generally used for pancreatic cancer). Traditionally performed open, this operation is now being done robotically at high-volume centers using just five small incisions.
Recent data support this shift. A large propensity-matched study using the Japanese National Clinical Database found that robotic pancreaticoduodenectomy was associated with significantly lower rates of severe postoperative complications compared with open surgery (22.2% vs. 25.9%). Clinically relevant postoperative pancreatic fistula rates were also reduced (19.3% vs. 24.5%), and median postoperative length of stay was five days shorter.
Malhotra notes that robotic surgery has had a particularly significant impact in liver resections. “Sometimes we have to do a large cut transversely across the abdomen, cutting through muscle right underneath the ribcage, in order to get to difficult-to-reach spots in the liver,” he says. “If we can do that same operation robotically, we spare the patient such a big incision, and they have significantly shorter hospital stays and improved outcomes.”
One illustrative case: a left lateral sectionectomy Malhotra recently performed robotically allowed the patient to go home the following day — a 23-hour observation stay versus the typical four- to five-day hospitalization.
A single-center study of 185 patients in Germany found that robotic liver resection was associated with reduced median blood loss (200 mL vs. 400 mL) and shorter hospital stays (9 days vs. 13 days) compared with open surgery, with equivalent R0 resection rates. A Danish propensity-matched analysis similarly demonstrated shorter length of stay (3.5 vs. 6.3 days) and lower transfusion rates with robotic liver surgery.
The evolution of robotic platforms has been critical to these advances. “In the world of minimally invasive surgery, the traditional way has been laparoscopic, with straight-stick instruments that move in just four directions: up, down, right and left,” Malhotra explains. “The big advance with robotics is wristed instruments. Instead of four degrees of movement, they offer seven — like having your own wrist. This allows us to do many of the same things we could do in open surgery, but in a minimally invasive fashion.”
In the latest advance, the newest da Vinci systems incorporate haptic feedback, allowing surgeons to perceive the forces exerted on tissue through the console — a feature previously absent in robotic platforms that better allows surgeons to “feel” what they’re doing while using metal hands.
While many hospitals now have robotic platforms, Malhotra emphasizes that the critical differentiator is experience and expertise. “Complex HPB surgery requires specialized training, multidisciplinary infrastructure and sufficient case volume, resources that are generally concentrated at high-volume centers,” he explains. At Keck Medicine, patients benefit from high-volume HPB surgeons with specialized robotic training and experience.
For patients with HPB malignancies — including pancreatic cancer, cholangiocarcinoma, gallbladder cancer or colorectal liver metastases — a referral to Keck Medicine provides access to the latest in robotic surgical care. The result: oncologically sound resections with the potential for faster recovery and improved quality of life.
Share
