ArticleAnnals of surgery open : perspectives of surgical history, education, and clinical approaches2022
Complexity-Adjusted Learning Curves for Robotic and Laparoscopic Liver Resection: A Word of Caution.
Article in Annals of surgery open : perspectives of surgical history, education, and clinical approaches, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Comparative effectiveness and safety of robotic versus laparoscopic liver resection for benign liver diseases: a systematic review and meta-analysis.BMC gastroenterology · 2026Pooled it
- Transition from laparoscopic to robotic hepatectomy within a minimally invasive liver surgery program: risk-adjusted learning curve assessment by multiple continuous outcomes.Journal of robotic surgery · 2026Article
- Transitioning to the robotic era for perihilar cholangiocarcinoma: initial implementation and outcomes in a single center.Surgical endoscopy · 2026Article
- Assessment of the learning curve of robotic liver resection using complexity-adjusted CUSUM analysis.Journal of robotic surgery · 2026Article
- [Influencing factors and results of conversions in minimally invasive liver surgery : A single-center analysis of over 1200 consecutive cases].Chirurgie (Heidelberg, Germany) · 2026Article
- Reaching proficiency in robotic liver surgery in two high-volume European HPB centers.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
- International Benchmark Values for Robotic Right Hepatectomy: Multicenter Study From 22 Expert Centers.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2025Article
- Fetoscopic Robotic Open Spina Bifida Treatment (FROST): A Preclinical Feasibility and Learning Curve Study.BJOG : an international journal of obstetrics and gynaecology · 2025Article
- One hundred and fifty-two robotic hepatectomies at a North American hepatobiliary program: Evolution of practice, learning curve, appraisal of outcomes, and cost analysis.Surgical endoscopy · 2025Article
- Experience-based transition to robotic surgery in an experienced program in minimally invasive hepatobiliary surgery.Surgical endoscopy · 2024Article
- Integrating the new systemic treatment landscape and surgical therapy in hepatocellular carcinoma.Turkish journal of surgery · 2024Review
- Concomitant training in robotic and laparoscopic liver resections of low-to-intermediate difficulty score: a retrospective analysis of the learning curve.Scientific reports · 2024Article
- Impact of complexity in minimally invasive liver surgery on enhanced recovery measures: prospective study.BJS open · 2024Observational
- Impact of shifting from laparoscopic to robotic surgery during 600 minimally invasive pancreatic and liver resections.Surgical endoscopy · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
12 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Minimally invasive liver surgery (MILS) has a high variance in the type of resection and complexity, which has been underestimated in learning curve studies in the past. The aim of this work was to evaluate complexity-adjusted learning curves over time for laparoscopic liver resection (LLR) and robotic liver resection (RLR). Methods: Cumulative sum analysis (CUSUM) and complexity adjustment were performed using the Iwate score for LLR and RLR (n = 647). Lowest point of smoothed data was used to capture the cutoff of the increase in complexity. Data were collected retrospectively at the Department of Surgery of the Charité-Universitätsmedizin Berlin. Results: A total of 132 RLR and 514 LLR were performed. According to the complexity-adjusted CUSUM analysis, the initial learning phase was reached after 117 for LLR and 93 procedures for RLR, respectively. With increasing experience, the rate of (extended) right hemihepatectomy multiplied from 8.4% to 18.9% for LLR ( Conclusions: The learning phase for MILS after adjusting for complexity is about 4 times longer than assumed in previous studies, which should urge caution.
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.