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Robotic major and minor hepatectomy: critical appraisal of learning curve and its impact on outcomes

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Abstract

Background

Robotic 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.

Methods

Between 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.

Results

Proficiency 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.

Conclusion

In 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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Authors and Affiliations

  1. Department of Surgical Oncology, School of Medicine-Wichita, University of Kansas, 818 N Emporia Ave, Wichita, KS, 67214, USA

    Ali Ahmad, Hadley D. Freeman & Sarah D. Corn

Authors
  1. Ali Ahmad
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  2. Hadley D. Freeman
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  3. Sarah D. Corn
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Corresponding author

Correspondence to Ali Ahmad.

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Disclosures

Ali Ahmad has received honoraria for teaching didactic courses and proctoring other surgeons by Intuitive Surgical, USA. Hadley D Freeman, Sarah D Corn have no conflict of interest or financial ties to disclose.

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Ahmad, A., Freeman, H.D. & Corn, S.D. Robotic major and minor hepatectomy: critical appraisal of learning curve and its impact on outcomes. Surg Endosc 37, 2915–2922 (2023). https://doi.org/10.1007/s00464-022-09809-3

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  • DOI: https://doi.org/10.1007/s00464-022-09809-3

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