The Rise of Robot-Assisted Surgery in the Netherlands

To assess nationwide trends in the use of robot-assisted surgery (RAS) for high-complex, low-volume resections in the Netherlands. RAS is growing globally, offering substantial value in high-complex, low-volume gastrointestinal and thoracic surgery. However, nationwide data on its adoption are lacking. The Netherlands maintains mandatory clinical audits for major oncologic surgeries, offering a unique opportunity to evaluate RAS adoption. All patients undergoing pancreatic, colorectal, liver, thoracic, and esophagogastric cancer surgery registered in national audits in the Netherlands were included (audit start-2023). Primary endpoint was annual RAS rate. Secondary endpoints included number of centers performing RAS and trends in patient, tumor and treatment characteristics of RAS patients. In total, 77,361 resections were included: 10,336 pancreatic, 29,821 thoracic, 30,256 colorectal, 4,762 liver and 2,186 esophagogastric. Nationwide RAS use increased from 1% to 33% in pancreatic (2014-2023), 3% to 11% in thoracic (2016-2023), 6% to 14% in colon, 19% to 45% in rectal (2018-2023), 10% to 25% in liver (2020-2023), and 33% to 40% in esophageal, and remained 19% in gastric surgery (2022-2023). By 2023, RAS was used in 20% of all procedures, with 15/16 (94%) pancreatic centers performing RAS, compared to 12/42 (29%) in thoracic surgery. RAS was adopted mostly in left pancreatectomy (50%), total mesorectal excisions (48%) and mediastinal tumor resections (46%). RAS expanded across multiple patient and tumor types within all disciplines. This study confirms a steep nationwide rise in RAS use for rectal, pancreatic, esophageal, liver, gastric, colon and thoracic surgery, with greater adoption in certain procedures and overseen by national audits.

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Publication Details

Journal
Annals of Surgery
Published
2025-09-18
DOI
https://doi.org/10.1097/sla.0000000000006944
Primary Topic
Pancreatic and Hepatic Oncology Research
Type
article
Field-Weighted Citation Impact
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article

The Rise of Robot-Assisted Surgery in the Netherlands

J.P.M. Burbach, Koen J. Hartemink, Marc G. Besselink, Mark I. van Berge Henegouwen et al.
Annals of Surgery
Pancreatic and Hepatic Oncology Research
article

The Rise of Robot-Assisted Surgery in the Netherlands

J.P.M. Burbach, Koen J. Hartemink, Marc G. Besselink, Mark I. van Berge Henegouwen, Rutger‐Jan Swijnenburg, Ad F. T. M. Verhagen, Nienke Wolfhagen, Esther C. J. Consten, Bas Groot Koerkamp, Suzanne Sarah Gisbertz, Richard van Hillegersberg, T. Hendriks, George P. van der Schelling, Michelle R. de Graaff, Jan Willem T. Dekker, Maurits R. Visser, Femke J. Amelung, Izaak Quintus Molenaar, Jelle P. H. Ruurda, Frank J. Voskens, Jeroen Hagendoorn, Robert Luger, R. den Boer, M. Liem
article en

Abstract

To assess nationwide trends in the use of robot-assisted surgery (RAS) for high-complex, low-volume resections in the Netherlands. RAS is growing globally, offering substantial value in high-complex, low-volume gastrointestinal and thoracic surgery. However, nationwide data on its adoption are lacking. The Netherlands maintains mandatory clinical audits for major oncologic surgeries, offering a unique opportunity to evaluate RAS adoption. All patients undergoing pancreatic, colorectal, liver, thoracic, and esophagogastric cancer surgery registered in national audits in the Netherlands were included (audit start-2023). Primary endpoint was annual RAS rate. Secondary endpoints included number of centers performing RAS and trends in patient, tumor and treatment characteristics of RAS patients. In total, 77,361 resections were included: 10,336 pancreatic, 29,821 thoracic, 30,256 colorectal, 4,762 liver and 2,186 esophagogastric. Nationwide RAS use increased from 1% to 33% in pancreatic (2014-2023), 3% to 11% in thoracic (2016-2023), 6% to 14% in colon, 19% to 45% in rectal (2018-2023), 10% to 25% in liver (2020-2023), and 33% to 40% in esophageal, and remained 19% in gastric surgery (2022-2023). By 2023, RAS was used in 20% of all procedures, with 15/16 (94%) pancreatic centers performing RAS, compared to 12/42 (29%) in thoracic surgery. RAS was adopted mostly in left pancreatectomy (50%), total mesorectal excisions (48%) and mediastinal tumor resections (46%). RAS expanded across multiple patient and tumor types within all disciplines. This study confirms a steep nationwide rise in RAS use for rectal, pancreatic, esophageal, liver, gastric, colon and thoracic surgery, with greater adoption in certain procedures and overseen by national audits.

Annals of Surgery
Leiden University (NL), University Medical Center Groningen (NL), Radboud University Nijmegen (NL), Utrecht University (NL), University of Applied Sciences Leiden (NL), Leiden University Medical Center (NL), Medisch Spectrum Twente (NL), Erasmus MC (NL), Radboud University Medical Center (NL), The Netherlands Cancer Institute (NL), University Medical Center Utrecht (NL), Reinier de Graaf Hospital (NL), Dutch Institute for Clinical Auditing (NL), Amphia Ziekenhuis (NL), Amsterdam University Medical Centers (NL), Meander Medisch Centrum (NL), Cancer Center Amsterdam (NL), Vrije Universiteit Amsterdam (NL), University of Amsterdam (NL)
Openalex Percentile: Top 65%
Pancreatic and Hepatic Oncology Research
DOISourceOpenAlex
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