ArticleHepatobiliary surgery and nutrition2025
Evaluation of outcomes of robotic liver surgery using the IWATE criteria.
Article in Hepatobiliary surgery and nutrition, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.
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Who cites it
3 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Robotic hepatectomy for benign liver disease: single-centre consecutive series and meta-analysis comparing minimally invasive and open approaches.Journal of robotic surgery · 2026Pooled it
- Robotic hepatectomy across IWATE difficulty levels: a single-center experience of the first 100 cases.Journal of robotic surgery · 2026Article
- Does complexity compromise outcomes in robotic hepatectomy?Surgical endoscopy · 2026Article
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Authors and funding
8 authors.
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No grant is acknowledged in the PubMed record.
Abstract
Background: Robotic liver resections (RLRs) are increasingly performed worldwide. The IWATE criteria offer a standardized classification to correlate the complexity of these procedures with surgical outcomes. This study analyzes a single surgeon's experience with RLR and evaluates the applicability and correlation of the IWATE criteria. Methods: We conducted a retrospective analysis of 188 RLRs performed by a single surgeon at the University of Illinois at Chicago from June 2007 to May 2023. Data on patient demographics, surgical details, pathology, and 30-day morbidity and mortality were collected. Surgical data included operation duration, blood loss, conversion rates, intraoperative and perioperative complications, and length of hospital stay (LOS). Patients were categorized into four groups according to the IWATE criteria. Results: Patients were evenly distributed across the four groups, except for age and preoperative chemotherapy rates, which were significantly different. Operative times (OTs) and estimated blood loss (EBL) increased with procedure complexity, ranging from 148 to 350 minutes and 75 to 400 mL (P<0.001). There were 18 conversions (9.6%), with a significantly higher rate in the Expert and Advanced groups (P<0.001). Intraoperative transfusions followed the same pattern. Postoperative outcomes showed a significant difference in median hospital stay (P<0.001), varying from 3 to 7 days (Low to Expert groups). There were 8 major complications and a 3.7% readmission rate, with no 30-day mortality, and no significant difference in complication distribution among groups. The overall R0 resection rate was 96.3%. Conclusions: The IWATE criteria effectively correlate with surgical outcomes in our series, providing a valuable tool for standardizing procedure complexity and facilitating outcome comparisons.
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