Elsevier

Surgery

Volume 161, Issue 3, March 2017, Pages 642-649
Surgery

Liver
Robotic major hepatectomy: Is there a learning curve?

https://doi.org/10.1016/j.surg.2016.09.025Get rights and content

Background

Robotic hepatectomy has been suggested as a safe and effective management of liver disease. However, no large case series have documented the learning curve for robotic major hepatectomy.

Method

We conducted a retrospective study for robotic major hepatectomy performed by the same operative team between January 2012 and October 2015 and evaluated the learning curve for operation time using the cumulative sum method, presented as cumulative sumoperation time.

Results

Overall, there were 183 robotic hepatectomies, 92 of which were performed in patients who underwent robotic major hepatectomy: left hemihepatectomy was performed in 32 (34.8%) patients, right hemihepatectomy in 41 (44.6%), left trisectionectomy in 3 (3.3%), right trisectionectomy in 6 (6.5%), and 8-5-4 trisegmentectomy in 10 (10.8%). The median duration of surgery was 434 minutes (142–805 minutes) and the median blood loss was 195 mL (50–2,000 mL). Fifty-nine percent of patients had malignancies, and those with advanced stages of cancer had more blood loss during an operation. The cumulative sumoperation time model of robotic major hepatectomy suggested that the learning curve comprised 3 characteristic phases: initial (phase 1, 15 patients), intermediate (phase 2, 25 patients), and mature (phase 3, 52 patients). The learning effects were underlined by shorter operation time and hospital stay after phase 1 and less blood loss after phase 2.

Conclusion

This is the largest series regarding robotic major hepatectomy. Our findings suggest that a solid training program based on the learning curve should be considered for beginners of robotic hepatectomy. Participants should evaluate the evolution of our minimally invasive hepatectomy before considering our robotic experience.

Section snippets

Methods

This was a retrospectively designed study from the review of the medical records. All procedures were approved by the institution's supervisory committee, and this study was approved by the institutional review board. All procedures were performed by the same operative team.

Major hepatectomy was defined as the resection of ≤3 contiguous Couinaud segments. All consecutive patients who underwent RMH at our hospital between January 2012 and October 2015 were selected for the study. Patients with

Results

During the study period, >50% of the 183 patients who underwent robotic hepatectomy had major procedures (Table I). For the 92 patients who underwent RMH, the median age was 53 years (range 19–87 years); there were 53 men and 39 women. Regarding RMH, hepatocellular carcinoma was accounted for the majority (60%) of overall indications. All patients with malignant disease underwent histopathologically proven R0 resection, with no evidence of cancer in the resection margins. Among the procedures

Discussion

In our review of minimally invasive major hepatectomies, few documents regarding laparoscopic major hepatectomy of a single institute have been reported, including 96 cases from Koffron et al,22 62 cases from Buell et al,23 and 173 cases from Nomi et al.14 However, the adoption of minimally invasive major liver resection in clinical practice has been gradual; the worldwide trend has increased slowly from 16–22% during the past 5 years.24, 25 Although inherited from conventional laparoscopy,

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    The authors have no conflicts of interest or financial ties to disclose.

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