Minimally Invasive Surgery (laparoscopic and robotic)

Minimally-invasive surgery (MIS) (also known as “key-hole surgery”) has been proven to be associated with numerous advantages over the traditional open approach such decrease pain, faster recovery, decreased blood lost and lower wound infection rates. However, many surgeons and centers today still prefer to perform major HPB operations via open surgery (long open incisions) due to the complexity of these procedures. Several members of our department are highly adept in all aspects of MIS HPB surgery.

The department is a global and regional thought leader in the field with its vast experience in performing MIS (laparoscopic and robotic surgery) for complex liver, pancreatic and biliary procedures and is well-recognized internationally for its expertise. Presently, it is one of the highest volume centers in the field for MIS HPB surgery in the region.  Since starting its MIS program for liver and pancreatic resections in 2006, it has performed about 1500 MIS procedures for major HPB surgeries including over 950 MIS liver resections and 350 MIS major pancreatic resections as of 2022. 

It is also the pioneer of robotic HPB surgery in the region, starting its formal program in 2013 and has performed over 160 robotic major HPB procedures as of 2022. Presently, robotic surgery is used selectively to complement conventional laparoscopy allowing more complex procedures to be completed successfully via the minimally-invasive approach.

 Its surgical results (open conversion rate, morbidity and mortality) for MIS are on par with the very best centers worldwide and has been published in numerous prestigious international journals [1-7]. At present, its 30-day mortality rate for major HPB procedures performed via MIS is less than 0.5 %.

Today, with its extensive experience with MIS, virtually all types of major HPB procedures can be performed routinely via the MIS approach including major hepatectomies, major pancreatic surgeries including pancreatoduodenectomies (Whipples procedure) and hepaticojejunostomies. The MIS approach is now also performed frequently for recurrent cancers after previous open surgeries, very large tumors (> 10-15 cm) and tumors involving major blood vessels. Due to its expertise, the department is also a global thought leader in the field and has lead numerous international multicenter studies and has been part of several international expert consensus guidelines [8-13].

Complete surgical resection remains the only curative treatment for most HPB cancers. However, frequently, these cancers are considered inoperable due to involvement of major blood vessels or adjacent critical organs. The department is experienced in treating these cancers using highly sophisticated surgical techniques to enable complete surgical removal for cancers considered inoperable by most surgeons. It currently performs highly complicated and innovative surgical procedures such as associating liver partition and portal vein ligation (ALPPS), cold in-situ perfusion and complex vascular reconstructions [14] to ensure the best chance of complete oncology clearance.

The department is experienced in all aspects of liver transplantation and performs complicated transplants such as ABO incompatible liver transplantation and small-for-size graft living donor liver transplantation. Due to its extensive experience in MIS-HPB surgery, it is also one of a small number of transplant centers routinely performing pure laparoscopic donor hepatectomy for adult living donor liver transplantation. It pioneered several complicated transplant procedures in the region such as the first combined heart-liver transplant in Asia and the first ABOi liver transplant in the region.