Is there a Rapid Adaptation in Robotic Liver Surgery for a Liver Surgeon with a Large Experience in Laparoscopic Liver Surgery?

Abstract

Introduction: Robotic liver surgery (RLS) is currently limited to few high-volume centers. Its reproducibility is still debated. The aim of the present study was to evaluate the results of the first year of robotic liver surgery, performed by an early adopter in laparoscopic liver surgery (LLS) with experience in over 400 laparoscopic cases. Methods: Over a one-year period, 53 patients underwent a robotic hepatectomy. The outcomes of the robotic cases (RG) were compared to the ‘Initial Experience’-group (IE) of 120 laparoscopic cases, performed by the same surgeon. Subsequently, the robotic series were compared to his last 120 laparoscopic cases or ‘Mastery Phase’-group (MP). Results: The 3 groups were similar with regards to age, gender, tumor type and Iwate or Southampton difficulty score. Median skin-to-skin operative time of the RG was 140 min versus 130 min in the IE (p=0.026), and 108 min in the MP (p<0.001). Median intraoperative blood loss in the RG was less (40 ml (20-90)) compared to the IE (100 ml (50-250);p<0.001) and the MP (65ml (30-143;p=0.004). Median hospital stay was 3 days in both the RG and MP, versus 5 days in the IE (p<0.001). There was no significant difference in postoperative complications, conversion or readmission rate. Conclusion: Surgeons with sufficient experience in LLS can rapidly overcome the learning curve for RLS. In our experience, the short-term outcomes of the implementation phase of RLS are similar to the mastery phase of LLS. Blood loss was significantly lower in RLS.