Dr. Iswanto Sucandy Presented at the International Asian Laparoscopic HPB Surgery Conference

Concomitant Biliary Reconstruction for Bile Duct Cancer

As professional medical conferences have moved to virtual formats due to COVID pandemic, many surgeons including Dr. Sucandy participate via remote conferences. In early 2021, Dr Sucandy was invited to present at the 3rd Annual Association of Southeast Asian Nations (ASEAN) Laparoscopic Hepatopancreatobiliary (HPB) Surgery Conference. He was initially expected to travel for a live podium presentation in Manila, a 16 hour aerotrip from Tampa, Florida. Instead, he gave a virtual presentation at 2 a.m, sharing experience with hundreds of experienced International liver surgeons working in Asia. Many of them are giants in this field.

“It is truly a great honor to be invited internationally to deliver this talk, especially by highly regarded experienced surgeons in Asia,” says Dr. Sucandy. The highest complexity and the finest minimally invasive liver, pancreas and biliary surgery is typically not performed by surgeons in the West, but in Asian countries, mostly out of necessity. The incidence of liver cancer is far higher in Asia due to widespread hepatitis B and C infections, leading to liver cirrhosis. Destruction of liver background by chronic viral inflammation ultimacalltoy induces liver cancer. Many of the liver cancers are diagnosed at advanced stages due to lack of universal medical care, creating much higher technical challenges for the operating surgeons.

Nearly 1,000 attendees were present to participate virtually, to learn from and be inspired by the speakers, The common goal is to give patients better minimally invasive surgery liver surgery outcomes. Minimally invasive surgery uses small 5-8mm incisions and a high definition camera that can see inside the abdomen. Because this approach results in less tissue trauma, patients recover from their operations much faster with less pain and cardiopulmonary complications. Dr Sucandy is a world pioneer in robotic liver surgery. Today, the use of surgical robot in liver surgery is still rare and limited to only certain high-volume centers that have much expertise in robotic surgery.

Robotic Liver Surgery by Dr. Sucandy: A Safer & Highly Precise Technique
With minimally invasive major liver resection, the robotic system gives the surgeon certain advantages over traditional laparoscopy (a surgical method using straight instruments).

  1. A lower chance to convert to an open procedure. With laparoscopic liver surgery, surgeons often run into issues that cause them to have to open the patients such as massive bleeding, inability to reach deep tumor locations or technical challenge in bile duct suturing/reconstruction. This can be as high as 30%. Dr. Sucandy has about 0.5% conversion rate for robotic liver surgery with the use of robotic system. This is a very important point since crash open conversion often leads to detrimental effects for patient’s recovery.
  2. Superior view of the liver structures. The surgical robot comes with 3D camera with stable platform. This is an advantage over traditional laparoscopy, which often comes with a regular laparoscopic camera.
  3. A pure minimally invasive approach since the robotic liver surgery does not include /need placing a hand into the abdomen (hybrid approach).
  4. An option for patients who have had prior open abdominal operation or prior liver operations. All of these factors contribute to an increased technical difficulty when performing liver resection. Scar tissues around the liver can be very dense and liver anatomy may have changed from prior resection. In most centers, these kind of patients have to undergo open operation. In our program, 54% of patients have some sorts of prior abdominal or liver operations, however, they can still be served with robotic liver surgery without problems.

Robotic Complex Liver & Bile Duct Surgery by Dr. Sucandy To Treat Cholangiocarcinoma
Dr. Sucandy shared his experience not just about major liver surgery but also about complicated cases that required him and his team to resect and rebuild the bile ducts in and around the liver. Dr Sucandy resected bile duct cancer / cholangiocarcinoma/ Klatskin Tumor using Da Vinci robot. His results have now finally been published in the Journal of Surgical Oncology in September 2021*. This is the first series in the United States that describes the use of minimally invasive method for Klatskin tumor resection. This modern technique revolutionizes method to treat Cholangiocarcinoma, a deadly cancer which otherwise requires a major open operation. The results are excellent and the recovery is much shorter when compared to the open resection.