The Learning Curve of Hepatobiliary Robotic Surgery: The First 100 Cases

Abstract

Introduction: Minimally invasive surgery has been increasingly and successfully used across different surgical areas. Minimally invasive liver surgery (MILS) is an expanding field, and robotic surgery is currently in the frontline. The authors present the first Portuguese robotic liver surgery series. Methods: Clinical-pathological data was prospectively collected between October 2019 and August 2021. A retrospective review of the most relevant variables and results was performed. Statistical analysis was performed using SPSS 26. Results: At our institution, 100 consecutive patients were submitted to robotic hepatobiliary surgery. Median age was 60 years old (18-80). Malignancy was the most frequent indication for surgery n=67 (Liver colorectal metastasis n=36, hepatocellular carcinoma n=17, cholangiocarcinoma n=4). 39 patients were submitted to a major hepatectomy and the average intervention duration was 253 min (70-740min). Starting with minor operations, increasingly complex procedures, such as central hepatectomy of liver resection for perihilar cholangiocarcinoma, were performed. Conversion rate to open surgery was 3%, and average blood loss was 226cc. Three patients required transfusional support during the perioperative period. We report a morbidity rate of 13% (major: 4 patients) and a mortality rate of 1%. The median duration of post-operative hospital stay was 4 days (1-19). Conclusion: This represents the first and only reported Portuguese series of robotic hepatobiliary surgery. Robotic surgery can be safely performed for major liver resections with a low rate of conversion and post-operative complications. The introduction of robotics may be one of the most significant recent achievements in the field of liver surgery.