The Rise of Robot-Assisted Surgery in the Netherlands: An Overview of its Adoption over the Last Decade.

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.