Learning Curve of Robotic Liver Surgery: Preliminary Experience

Abstract

Background

The daily implementation of robotic programmes for general surgery has allowed for the diffusion of the robotic approach in clinical practice in many centres with relatively little experience in laparoscopic liver resection.

Methods

This study describes our preliminary experience with robotic liver resection (RLR) using the da Vinci Xi Surgical System^®, beginning with assistance provided by an expert robotic colorectal team. Between 2022 and 2024, data on 61 consecutive minor RLRs performed by a single hepatobiliary team were retrospectively analysed. Intraoperative blood loss and operative time were used to construct learning curves.

Results

In the first phase of the learning curve (competency; cases 1-20), surgeons focused on acquiring basic surgical skills. Most cases involved non-anatomical wedge resections of superficial liver lesions with a low IWATE score. From the 14th case onwards, a significant improvement in operative time and a reduction in blood loss were observed. During the second phase of the learning curve (proficiency; cases 21-50), the surgical cases became more complex. The cumulative operative time increased progressively, reaching a plateau around the forty-first case. Blood loss initially increased but then gradually stabilised below 400 mL. During the early mastery phase of the learning curve (cases 51-61), the IWATE score continued to increase (mean 8), whereas the cumulative operative time and blood loss were stable.

Conclusions

We believe that the success of our initial robotic programme is due not only to technological advancement, but also to the continuous development and effective collaboration of the multidisciplinary colorectal and liver team.