10 years, 100 robotic major hepatectomies: a single-center experience

Introduction Adoption of robotic liver resections has been gradually increasing throughout the HPB surgical community over the past decade. Currently there is limited literature which demonstrates a significant benefit of robotic surgery for major hepatectomies over open or laparoscopic. As one of the first centers to develop a robotic HPB program, we have experienced improved outcomes over time with increasing utilization of robotics. Herein, we present our 10-year experience and outcomes for major robotic liver resections.Methods From 2012 to 2022, 361 robotic liver procedures were performed, including 100 major hepatectomies. A retrospective data review of the electronic medical record was performed evaluating outcomes after robotic major hepatectomy. Outcomes for the first 50 cases (Group A) and second 50 cases (Group B) were compared to identify any improvements in practice. Demographic and clinical outcome variables were analyzed. Data were assessed for normality, and Wilcoxon rank-sum, chi(2) tests, and a logistic regression model were performed appropriate for the data. Stata v.17 was utilized, and significance was set as p < .05.Results There was no difference in median operative time (258 vs 256 min), EBL (500 vs 500 mL), median LOS (5 vs 3.5 days), 90-day readmission (14% vs 24%), major complications (14% vs 20%), and 90-day mortality (6% vs 4%) between early and late cases, respectively. ICU admissions and conversion rates were significantly lower in group B (14.0% vs 48.0%), while expert level difficulty indices were higher (82% vs 58%).Conclusion Development of a robotic liver program with good outcomes is feasible over time. Our data suggest that our institutional learning curve for robotic major hepatectomy plateaued at approximately 50 cases.

Automated summary

This study retrospectively evaluated the outcomes of 361 robotic liver procedures, including 100 major hepatectomies. The results showed no significant differences in operative time, estimated blood loss, length of stay, readmission rate, major complications, and mortality between the first 50 cases and the second 50 cases. However, the ICU admission rate and conversion rate were significantly lower in the second group, while the expert level difficulty index was higher.