Improving Outcomes Defending Patient Safety: The Learning Journey in Robotic Liver Resections

Overview

Journal Biomed Res Int

Publisher Wiley

Specialties Biomedical Engineering
Biotechnology
General Medicine

Date 2019 May 14

PMID 31080809

Citations 12

Authors

Paolo Magistri

Gian Piero Guerrini

Roberto Ballarin

Giacomo Assirati

Giuseppe Tarantino

Fabrizio Di Benedetto

Affiliations

Soon will be listed here.

Abstract

Background: While laparoscopy is currently adopted for hepatic resections, robotic approaches to the liver have not gained wide acceptance. We decided to analyze the learning curve in the field of robotic liver surgery comparing short-term outcomes between the first and the second half of our series.

Methods: We retrospectively reviewed demographics and clinical data of patients who underwent robotic liver resection at our institution from July 2014 through September 2017. 60 patients diagnosed with primary or secondary liver neoplasms or hydatid disease were included in this study. ASA PS >3, heart failure, respiratory insufficiency, and general contraindication to pneumoperitoneum were exclusion criteria.

Results: 60 patients were included. We observed a statistically significant decrease in operative time (p<0.001), intraoperative blood loss (p=0.01), and postoperative complications (p<0.001) after 30 cases. From the interpretation of the CUSUM curve, the time of operation appears to be significantly reduced after the first 30 operations.

Discussion: This is the first European analysis of the learning curve for robotic liver resection in an HPB and liver transplant referral center. However, more studies are needed to confirm such results outside a HPB referral center. This is crucial to develop formal credentialing protocols for both junior and senior surgeons.

Citing Articles

Learning curve analysis of 100 consecutive robotic liver resections.

Rahimli M, Gumbs A, Perrakis A, Al-Madhi S, Dolling M, Stelter F Surg Endosc. 2025; .

PMID: 40014140 DOI: 10.1007/s00464-025-11551-5.

The Role of Robotics in Meeting Institutional Goals: A Unified Strategy to Facilitate Program Excellence.

Choo S, Jeon M, Kim Y, Choi S, Yi J, Lee T Int Neurourol J. 2024; 28(2):127-137.

PMID: 38956772 PMC: 11222821. DOI: 10.5213/inj.2448146.123.

Towards a Standardization of Learning Curve Assessment in Minimally Invasive Liver Surgery.

Kuemmerli C, Toti J, Haak F, Billeter A, Nickel F, Guidetti C Ann Surg. 2024; .

PMID: 38920042 PMC: 11723502. DOI: 10.1097/SLA.0000000000006417.

Concomitant training in robotic and laparoscopic liver resections of low-to-intermediate difficulty score: a retrospective analysis of the learning curve.

Bernardi L, Balzano E, Roesel R, Ghinolfi D, Vagelli F, Menconi G Sci Rep. 2024; 14(1):3595.

PMID: 38351030 PMC: 10864263. DOI: 10.1038/s41598-024-54253-z.

Robotic open resection for colorectal liver metastases in a "referral centre Hub&Spoke learning program". A multicenter propensity score matching analysis of perioperative outcomes.

Rocca A, Avella P, Scacchi A, Brunese M, Cappuccio M, De Rosa M Heliyon. 2024; 10(3):e24800.

PMID: 38322841 PMC: 10844024. DOI: 10.1016/j.heliyon.2024.e24800.

References

Dindo D, Demartines N, Clavien P . Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240(2):205-13. PMC: 1360123. DOI: 10.1097/01.sla.0000133083.54934.ae. View

McCulloch P, Altman D, Glasziou P, Marshall J, Aronson J, Barkun J . No surgical innovation without evaluation: the IDEAL recommendations. Lancet. 2009; 374(9695):1105-12. DOI: 10.1016/S0140-6736(09)61116-8. View

Vigano L, Laurent A, Tayar C, Tomatis M, Ponti A, Cherqui D . The learning curve in laparoscopic liver resection: improved feasibility and reproducibility. Ann Surg. 2009; 250(5):772-82. DOI: 10.1097/SLA.0b013e3181bd93b2. View

Giulianotti P, Coratti A, Sbrana F, Addeo P, Bianco F, Buchs N . Robotic liver surgery: results for 70 resections. Surgery. 2010; 149(1):29-39. DOI: 10.1016/j.surg.2010.04.002. View

Costi R, Scatton O, Haddad L, Randone B, Andraus W, Massault P . Lessons learned from the first 100 laparoscopic liver resections: not delaying conversion may allow reduced blood loss and operative time. J Laparoendosc Adv Surg Tech A. 2012; 22(5):425-31. DOI: 10.1089/lap.2011.0334. View

Packiam V, Bartlett D, Tohme S, Reddy S, Marsh J, Geller D . Minimally invasive liver resection: robotic versus laparoscopic left lateral sectionectomy. J Gastrointest Surg. 2012; 16(12):2233-8. PMC: 3509231. DOI: 10.1007/s11605-012-2040-1. View

Ban D, Tanabe M, Ito H, Otsuka Y, Nitta H, Abe Y . A novel difficulty scoring system for laparoscopic liver resection. J Hepatobiliary Pancreat Sci. 2014; 21(10):745-53. DOI: 10.1002/jhbp.166. View

Yu Y, Kim K, Jung D, Namkoong J, Yoon S, Jung S . Robotic versus laparoscopic liver resection: a comparative study from a single center. Langenbecks Arch Surg. 2014; 399(8):1039-45. DOI: 10.1007/s00423-014-1238-y. View

Szold A, Bergamaschi R, Broeders I, Dankelman J, Forgione A, Lango T . European Association of Endoscopic Surgeons (EAES) consensus statement on the use of robotics in general surgery. Surg Endosc. 2014; 29(2):253-88. DOI: 10.1007/s00464-014-3916-9. View

10.

Wakabayashi G, Cherqui D, Geller D, Buell J, Kaneko H, Han H . Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg. 2015; 261(4):619-29. DOI: 10.1097/SLA.0000000000001184. View

11.

Guerra F, Amore Bonapasta S, Annecchiarico M, Bongiolatti S, Coratti A . Robot-integrated intraoperative ultrasound: Initial experience with hepatic malignancies. Minim Invasive Ther Allied Technol. 2015; 24(6):345-9. DOI: 10.3109/13645706.2015.1022558. View

12.

Ratti F, Barkhatov L, Tomassini F, Cipriani F, Kazaryan A, Edwin B . Learning curve of self-taught laparoscopic liver surgeons in left lateral sectionectomy: results from an international multi-institutional analysis on 245 cases. Surg Endosc. 2015; 30(8):3618-29. DOI: 10.1007/s00464-015-4665-0. View

13.

Gonzalez-Ciccarelli L, Quadri P, Daskalaki D, Milone L, Gangemi A, Giulianotti P . Robotic approach to hepatobiliary surgery. Chirurg. 2016; 88(Suppl 1):19-28. DOI: 10.1007/s00104-016-0223-0. View

14.

Daskalaki D, Gonzalez-Heredia R, Brown M, Bianco F, Tzvetanov I, Davis M . Financial Impact of the Robotic Approach in Liver Surgery: A Comparative Study of Clinical Outcomes and Costs Between the Robotic and Open Technique in a Single Institution. J Laparoendosc Adv Surg Tech A. 2017; 27(4):375-382. PMC: 5397272. DOI: 10.1089/lap.2016.0576. View

15.

Magistri P, Tarantino G, Ballarin R, Coratti A, Di Benedetto F . Robotic liver surgery is the optimal approach as bridge to transplantation. World J Hepatol. 2017; 9(4):224-226. PMC: 5295162. DOI: 10.4254/wjh.v9.i4.224. View

16.

Tanaka S, Kubo S, Kanazawa A, Takeda Y, Hirokawa F, Nitta H . Validation of a Difficulty Scoring System for Laparoscopic Liver Resection: A Multicenter Analysis by the Endoscopic Liver Surgery Study Group in Japan. J Am Coll Surg. 2017; 225(2):249-258.e1. DOI: 10.1016/j.jamcollsurg.2017.03.016. View

17.

Efanov M, Alikhanov R, Tsvirkun V, Kazakov I, Melekhina O, Kim P . Comparative analysis of learning curve in complex robot-assisted and laparoscopic liver resection. HPB (Oxford). 2017; 19(9):818-824. DOI: 10.1016/j.hpb.2017.05.003. View

18.

Magistri P, Tarantino G, Guidetti C, Assirati G, Olivieri T, Ballarin R . Laparoscopic versus robotic surgery for hepatocellular carcinoma: the first 46 consecutive cases. J Surg Res. 2017; 217:92-99. DOI: 10.1016/j.jss.2017.05.005. View

19.

Lai E, Tang C . Training robotic hepatectomy: the Hong Kong experience and perspective. Hepatobiliary Surg Nutr. 2017; 6(4):222-229. PMC: 5554762. DOI: 10.21037/hbsn.2017.01.21. View

20.

Abu Hilal M, Aldrighetti L, Dagher I, Edwin B, Troisi R, Alikhanov R . The Southampton Consensus Guidelines for Laparoscopic Liver Surgery: From Indication to Implementation. Ann Surg. 2017; 268(1):11-18. DOI: 10.1097/SLA.0000000000002524. View