Robotic major hepatectomy: Is there a learning curve?

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 operati...

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Bibliographic Details
Published in:Surgery 2017-03, Vol.161 (3), p.642-649
Main Authors: Chen, Po-Da, MD, Wu, Chao-Yin, MD, Hu, Rey-Heng, MD, PhD, Chen, Chiung-Nien, MD, PhD, Yuan, Ray-Hwang, MD, PhD, Liang, Jin-Tung, MD, PhD, Lai, Hong-Shiee, MD, PhD, Wu, Yao-Ming, MD, PhD
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Blood Loss, Surgical
Female
Hepatectomy - adverse effects
Hepatectomy - education
Humans
Learning Curve
Length of Stay
Liver Diseases - pathology
Liver Diseases - surgery
Male
Middle Aged
Operative Time
Postoperative Complications - epidemiology
Retrospective Studies
Robotic Surgical Procedures - adverse effects
Robotic Surgical Procedures - education
Surgery
Treatment Outcome
Young Adult
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Summary: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.
ISSN:0039-6060
1532-7361
DOI:10.1016/j.surg.2016.09.025