ArticleSurgical endoscopy2023
Robotic major and minor hepatectomy: critical appraisal of learning curve and its impact on outcomes.
Article in Surgical endoscopy, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed, 21 citations in OpenAlex.
- Robotic hepatectomy across IWATE difficulty levels: a single-center experience of the first 100 cases.Journal of robotic surgery · 2026Article
- Robotic versus laparoscopic hepatectomy: an umbrella review of systematic reviews and meta-analyses.Surgery in practice and science · 2026Review
- Robotic liver surgery: a global snapshot. Results from an international survey.Surgical endoscopy · 2026Article
- The Hidden Cost of Precision: Financial, Training, and Environmental Trade-Offs in Robotic HPB Surgery.Journal of robotic surgery · 2026Review
- Reaching proficiency in robotic liver surgery in two high-volume European HPB centers.Journal of robotic surgery · 2026Article
- Robotic Hepatectomy for Primary Liver Cancer.Annals of surgical oncology · 2026Review
- Impact of patient factors on outcomes in robotic major and minor hepatectomy: importance of patient selection.Journal of robotic surgery · 2026Article
- Evaluation of 350 robotic liver resections performed by an early adopter in laparoscopic liver surgery: clinical outcomes and critical appraisal of the learning curve.Surgical endoscopy · 2025Article
- Cost-effectiveness and clinical impact of robotic-assisted hepatectomy.Journal of robotic surgery · 2025Article
- Complete transition from laparoscopic to robotic liver surgery achieves superior outcomes in difficult hepatectomies: a seven-year retrospective study.Surgical endoscopy · 2025Article
- A novel low-cost high-fidelity porcine model of liver metastases for simulation training in robotic parenchyma-preserving liver resection.Journal of robotic surgery · 2024Article
- Introduction of day-case robotic liver surgery: a case series from a tertiary hepatobiliary and pancreatic centre.Surgical endoscopy · 2024Article
- Towards a Standardization of Learning Curve Assessment in Minimally Invasive Liver Surgery.Annals of surgery · 2024Article
- Full robotic versus open ALPPS: a bi-institutional comparison of perioperative outcomes.Surgical endoscopy · 2024Article
- Minimal Invasive Versus Open Surgery for Colorectal Liver Metastases: A Multicenter German StuDoQ|Liver Registry-Based Cohort Analysis in Germany.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2023Article
- Robotic Versus Laparoscopic Major Hepatectomy: Conversion and Ability to Rescue.Annals of surgical oncology · 2023Article
Corrections and comments
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Authors and funding
3 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundRobotic hepatectomy has gained increasing acceptance across the US. Although the robotic approach offers significant technical advantages, it is still bound by the individual surgeon's learning curve. Proficiency in this approach should theoretically lead to improved peri-operative outcomes.
methodsBetween 2017 and 2020, data on 148 consecutive robotic hepatectomies performed by a single surgeon was retrospectively analyzed. Using cumulative sum (CUSUM) method, intraoperative blood loss (EBL) and operative time were used to assess learning curves for robotic major (n = 58) and minor (n = 90) hepatectomy patients. Perioperative outcomes were compared in regards with proficiency.
resultsProficiency for robotic major and minor hepatectomy was achieved after 22 cases and 34 cases, respectively. No significant differences were observed in patient demographics or tumor characteristics. For robotic major hepatectomy, when compared to early experience, proficiency was associated with a significant improvement in mean EBL (242 mL vs 118 mL, p = 0.0004), operative time (330 min vs 247 min, p = 0.0002), decreased overall complication rate (23% vs 3%, p = 0.039), and length of hospital stay (5.7 days vs 4.1 days, p = 0.004). No difference in conversion rate, mortality or 30 day readmission was seen. For robotic minor hepatectomy, proficiency was associated with significantly decreased mean EBL (115 mL vs 54 mL, p = 0.005), operative time (168 vs 125 min, p = 0.014), and length of hospital stay (2.8 days vs 2.1 days, p = 0.021). No difference was observed in conversion rate, overall complications, mortality or 30 day readmission.
conclusionIn the modern era, robotic hepatectomy offers a safe approach with excellent perioperative outcomes. Post learning curve proficiency is associated with significant improvements in perioperative outcomes in both major and minor hepatectomy. Results from our study can serve as a guide to surgeons and programs looking to adopt this technique.
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