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Introduction <p>Robotic-assisted liver surgery is increasingly adopted, offering many advantages over conventional laparoscopy. This study evaluates perioperative outcomes, learning curves, instrument use, and cost price of the first 350 robotic liver resections (RLRs) performed by a high-volume HPB surgeon with extensive open and laparoscopic experience. Additionally, we assess whether established laparoscopic difficulty scoring systems can reliably predict surgical complexity and outcomes in robotic procedures.</p> Methods <p>All RLRs performed by a single surgeon from February 2020 to April 2025 were identified from a prospectively maintained database. Perioperative outcomes were analyzed, and learning curves for minor, anatomically major, and technically major resections were defined using cumulative sum analysis of operative time. Multivariate regression was used to assess the impact of case volume and preoperative difficulty scores on operative time and blood loss. And&#xa0;a descriptive analysis of instrument use, robotic techniques, and cost price is provided.</p> Results <p>Of the 350 RLRs, 147 were minor, 43 were anatomically major, and 160 were technically major resections. Median operative time was 145&#xa0;min (IQR: 122–188), with median estimated blood loss of 30&#xa0;mL (IQR: 20–90). Our conversion rate to open surgery was 0.6% (<i>n</i> = 2). Major complications (Clavien-Dindo ≥ III) occurred in 6%, with a median hospital stay of 3&#xa0;days and a 90-day mortality rate of 1.1%. Learning plateaus were reached at 28 (minor) cases, 15 (anatomically major) cases, and 54 (technically major) cases. Case volume was not associated with operative time (<i>p</i> = 0.79) or blood loss (<i>p</i> = 0.93). In contrast, IWATE, Southampton, and IMM scores strongly predicted both (<i>p</i> &lt; 0.001). A clear instrument preference was observed; most procedures required the use of 3–4 instruments, and the mean hospitalization cost was €5,408.50.</p> Conclusion <p>Robotic liver resection is safe, feasible, and cost-effective in experienced hands, with a short learning curve and strong predictive value from laparoscopic difficulty scores.</p> Graphical abstract <p></p>

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Evaluation of 350 robotic liver resections performed by an early adopter in laparoscopic liver surgery: clinical outcomes and critical appraisal of the learning curve

  • 期刊论文

  • 发表日期：

    2025年10月1日

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  • Tom Vandaele,
  • Ismaël Chaoui,
  • Celine De Meyere,
  • Louis Desmet,
  • Jens Goemaere,
  • Isabelle Parmentier,
  • Bram Vanhoof,
  • Mathieu D’Hondt

摘要

Introduction

Robotic-assisted liver surgery is increasingly adopted, offering many advantages over conventional laparoscopy. This study evaluates perioperative outcomes, learning curves, instrument use, and cost price of the first 350 robotic liver resections (RLRs) performed by a high-volume HPB surgeon with extensive open and laparoscopic experience. Additionally, we assess whether established laparoscopic difficulty scoring systems can reliably predict surgical complexity and outcomes in robotic procedures.

Methods

All RLRs performed by a single surgeon from February 2020 to April 2025 were identified from a prospectively maintained database. Perioperative outcomes were analyzed, and learning curves for minor, anatomically major, and technically major resections were defined using cumulative sum analysis of operative time. Multivariate regression was used to assess the impact of case volume and preoperative difficulty scores on operative time and blood loss. And a descriptive analysis of instrument use, robotic techniques, and cost price is provided.

Results

Of the 350 RLRs, 147 were minor, 43 were anatomically major, and 160 were technically major resections. Median operative time was 145 min (IQR: 122–188), with median estimated blood loss of 30 mL (IQR: 20–90). Our conversion rate to open surgery was 0.6% (n = 2). Major complications (Clavien-Dindo ≥ III) occurred in 6%, with a median hospital stay of 3 days and a 90-day mortality rate of 1.1%. Learning plateaus were reached at 28 (minor) cases, 15 (anatomically major) cases, and 54 (technically major) cases. Case volume was not associated with operative time (p = 0.79) or blood loss (p = 0.93). In contrast, IWATE, Southampton, and IMM scores strongly predicted both (p < 0.001). A clear instrument preference was observed; most procedures required the use of 3–4 instruments, and the mean hospitalization cost was €5,408.50.

Conclusion

Robotic liver resection is safe, feasible, and cost-effective in experienced hands, with a short learning curve and strong predictive value from laparoscopic difficulty scores.

Graphical abstract