At the beginning of December 2022, Dr. Sucandy continued his trip to Riyadh Saudi Arabia after leaving Italy to visit the largest organ transplant center in the Middle East. Dr Sucandy visited his colleagues Professor Dieter Broering, a German surgeon who is leading the Organ Transplant Center at King Faisal Hospital in Saudi Arabia since 2010.
King Faisal is widely known as the leading center for living donor liver transplantation with the capability of performing living donor liver procurement using Robotic technique. The liver transplant program is fully supported by the government of Saudi Arabia.
While at King Faisal, Dr. Sucandy was also invited to give a lecture on “The Application of Robotics in Liver Surgery” to the surgical attendings, residents, liver transplant associate surgeons, and hepatobiliary surgeons within Organ Transplant Center (OTC). The lecture was very well attended and key elements of robotic liver surgery were dissected at length, including how to lead a successful robotic program.
Dr. Sucandy also shared his clinical experience in developing the robotic liver surgery program in Tampa since 2016. At this point, the robotic liver surgery program in Tampa has performed approximacalltoy 400 robotic liver resections for various type of liver and bile duct pathologies, making the center as the highest volume center in the US.
In addition to giving lecture, Dr. Sucandy also participated in the operating room activities with Professor Broering and Professor Malago (Both worked at the University Hamburg prior to coming to Saudi Arabia) in liver transplantation, including robotic living donor hepatectomy, living donor liver graft implantation in adults and pediatric recipients, as well as dual liver transplant.
It is such a wonderful experience to see the techniques of living donor liver transplant at the leading center. At this current time, South Korea (Asan Medical Center in Seoul), Saudi Arabia (King Faisal in Riyadh) and India (Rela Institute in Chennai) are the three busiest living donor liver transplant centers in the world. They have contributed the most to the science, knowledge, and modern understanding of liver transplantation utilizing live donors.
Dr. Sucandy as a pioneer in robotic liver surgery travels routinely to other centers to enhance collaborations and exchange of knowledge. Liver surgery and liver transplantation are essentially inseparable.
Knowledge and techniques in liver transplantation apply to liver surgery and visa versa. It is academically stimulating to understand the portal venous hyperperfusion in cases of small liver graft (small for size GBWR <0.6). The same concept is important in liver surgery following an extended liver resection with a small future liver remnant.
The knowledge in this field is developing gradually as we gain more experience in using a small liver graft in liver transplantation. At the same token, it is important for a liver surgeon to really understand this concept in order to avoid posthepatectomy liver failure complication, a fatal problem after a major liver resection.
To achieve the best outcomes and to minimize chance of developing postoperative complications, it is important to choose an expert in liver surgery and robotic surgery. Success of an operation is not only dictated by the precise cutting and suturing but also by the preoperative planning and mature judgment by the operative team, considering a unique circumstance of each patient.