Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2023 Jun 1;277(6):e1269-e1277.
doi: 10.1097/SLA.0000000000005600. Epub 2022 Jul 18.

Implementation and Outcome of Robotic Liver Surgery in the Netherlands: A Nationwide Analysis

Burak Görgec  1   2 , Maurice Zwart  1   2 , Carolijn L Nota  3 , Okker D Bijlstra  4 , Koop Bosscha  5 , Marieke T de Boer  6 , Roeland F de Wilde  7 , Werner A Draaisma  5 , Michael F Gerhards  8 , Mike S Liem  9 , Daan J Lips  9 , Hendrik A Marsman  8 , J Sven D Mieog  4 , Quintus I Molenaar  3 , Maarten Nijkamp  6 , Wouter W Te Riele  10 , Türkan Terkivatan  7 , Alexander L Vahrmeijer  4 , Marc G Besselink  1   2 , Rutger-Jan Swijnenburg  1   2   11 , Jeroen Hagendoorn  3 ; Dutch Liver Collaborative Group
Affiliations
Multicenter Study

Implementation and Outcome of Robotic Liver Surgery in the Netherlands: A Nationwide Analysis

Burak Görgec et al. Ann Surg. .

Abstract

Objective: To determine the nationwide implementation and surgical outcome of minor and major robotic liver surgery (RLS) and assess the first phase of implementation of RLS during the learning curve.

Background: RLS may be a valuable alternative to laparoscopic liver surgery. Nationwide population-based studies with data on implementation and outcome of RLS are lacking.

Methods: Multicenter retrospective cohort study including consecutive patients who underwent RLS for all indications in 9 Dutch centers (August 2014-March 2021). Data on all liver resections were obtained from the mandatory nationwide Dutch Hepato Biliary Audit (DHBA) including data from all 27 centers for liver surgery in the Netherlands. Outcomes were stratified for minor, technically major, and anatomically major RLS. Learning curve effect was assessed using cumulative sum analysis for blood loss.

Results: Of 9437 liver resections, 400 were RLS (4.2%) procedures including 207 minor (52.2%), 141 technically major (35.3%), and 52 anatomically major (13%). The nationwide use of RLS increased from 0.2% in 2014 to 11.9% in 2020. The proportion of RLS among all minimally invasive liver resections increased from 2% to 28%. Median blood loss was 150 mL (interquartile range 50-350 mL] and the conversion rate 6.3% (n=25). The rate of Clavien-Dindo grade ≥III complications was 7.0% (n=27), median length of hospital stay 4 days (interquartile range 2-5) and 30-day/in-hospital mortality 0.8% (n=3). The R0 resection rate was 83.2% (n=263). Cumulative sum analysis for blood loss found a learning curve of at least 33 major RLS procedures.

Conclusions: The nationwide use of RLS in the Netherlands has increased rapidly with currently one-tenth of all liver resections and one-fourth of all minimally invasive liver resections being performed robotically. Although surgical outcomes of RLS in selected patient seem favorable, future prospective studies should determine its added value.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Annual rate of open, laparoscopic, and robotic liver surgery in the Netherlands (2014–2020).
FIGURE 2
FIGURE 2
Annual proportion of robotic and laparoscopic liver surgery in all patients after minimally invasive liver surgery in the Netherlands (2014–2020).
FIGURE 3
FIGURE 3
Annual volume of robotic liver resections stratified for type of resection.
See this image and copyright information in PMC

References

    1. Nguyen KT, Gamblin TC, Geller DA. World review of laparoscopic liver resection—2,804 patients. Ann Surg. 2009;250:831–841. - PubMed
    1. Müller PC, Kuemmerli C, Cizmic A, et al. . Learning curves in open, laparoscopic, and robotic pancreatic surgery. Ann Surg Open. 2022;3:e111. - PMC - PubMed
    1. Mirnezami R, Mirnezami AH, Chandrakumaran K, et al. . Short- and long-term outcomes after laparoscopic and open hepatic resection: systematic review and meta-analysis. HPB. 2011;13:295–308. - PMC - PubMed
    1. Tzanis D, Shivathirthan N, Laurent A, et al. . European experience of laparoscopic major hepatectomy. J Hepatobiliary Pancreat Sci. 2013;20:120–124. - PubMed
    1. Martínez-Cecilia D, Cipriani F, Vishal S, et al. . Laparoscopic versus open liver resection for colorectal metastases in elderly and octogenarian patients. Ann Surg. 2017;265:1192–1200. - PubMed

Publication types