One-Hundred Consecutive Robotic Liver Resections: Initial Experience and Lessons Learned
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ID: 315742
2026
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Abstract
Abstract Background Following prior open and laparoscopic experience, robotic liver resection (RLR) was introduced in early 2023. Aims To analyze the results of the first 100 RLRs. Methods Data of consecutive RLRs (02/2023 to 11/2025) were prospectively collected. The primary endpoint was postoperative morbidity; secondary ones included other clinical outcomes within 90-days after surgery. Subgroup analysis included patients with repeat hepatectomy, multiple resection areas, RLRs complexity based on the Iwate criteria. Kruskal-Wallis and Chi-square tests were used for subgroup comparisons. Results In 100 consecutive patients (40% females, mean age 65 years, mean Charlson-comorbidity-index 7), main indications were hepatocellular carcinoma (n=38), colorectal-liver-metastases (n=32). Cirrhosis rate was 28%, and 18% of patients underwent repeat hepatectomy (prior hepatectomy≥1). Mean number of nodules was 2.2, involving posterior-superior liver segments in 54%. Non-anatomic resections were performed in 54%, and multiple resection areas in 32% of cases (range 2-9) with mean blood loss of 200 cc. Non-urgent conversion to laparotomy occurred in 4% and intraoperative ablation was associated with RLR in 13% of cases. Postoperative overall and major morbidity (CD≥3) rates were 26% and 7% respectively (grade B post-hepatectomy liver failure 2%, biliary leak 1%), without reoperations. Overall morbidity was nihil after repeat hepatectomies and similar in patients with one (25%) vs. multiple resections (28%). Mean hospital stay was 6 days, with 90d readmission of 6%. Mortality was 1% (massive myocardial infarction). Textbook outcomes were reached in 79% of RLRs. Based on Iwate criteria RLR difficulty was low (n=25), intermediate (n=46), advanced (n=21) or expert (n=8). Operative time, blood loss, hospital stay increased with increasing difficulty, while complications and textbook outcomes remained stable. Conclusion Transition to robotic hepatectomy could be safely achieved, with good short-term results maintained in complex subgroups like repeat hepatectomies, multiples resections or high Iwate scores.
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| Authors | L Bernardi, E Garosi, R Roesel, I Hunjan, V Sitta, B E Guillot, G Pozza, F Mongelli, D Christoforidis, P Majno-Hurst, A Cristaudi |
| Journal | the british journal of surgery |
| Year | 2026 |
| DOI |
10.1093/bjs/znag055.036
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| URL | |
| Keywords | Keywords not found |
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