The learning curve for robotic living donor right hepatectomy: Analysis of outcomes in 2 specialized centers

Abstract

Robotic surgery is an emerging minimally invasive option for living donor hepatectomy. Currently, there are no studies on the learning curve of robotic donor hepatectomy. Thus, we evaluated the learning curve for robotic donor right hepatectomy. We retrospectively reviewed prospectively collected data from consecutive living donors who underwent robotic hepatectomy at 2 specialized centers between 2016 and 2022. We estimated the number of cases required to achieve stable operating times for robotic donor right hepatectomy using cumulative sum (CUSUM) analysis. The complication rates were similar between the 2 centers (22.8% vs. 26.7%; p = 0.74). Most complications were graded as minor (70.4%). Analysis of the total operative time demonstrated that the learning curves reached a peak at the 17th case in center 1 and the 9th case in center 2. The average operation times for cases 1-17 versus 18-99 in center 1 were 603 versus 438 minutes ( p < 0.001), and cases 1-9 versus 10-15 in center 2 were 532 versus 418 minutes ( p = 0.002). Complication rates were lower after the learning curves were achieved, although this did not reach statistical significance. A comparison of outcomes between centers suggests that a standardized approach to this complex operation can be successfully transferred.

Graphical abstract

FIGURE 1

Total operative time (minutes) for robotic right donor hepatectomy from centers 1 and 2.

FIGURE 2

Results of cumulative sum analysis of robotic living donor right hepatectomy. (A) Total operative time, (B) console time, (C) hilar dissection time.

FIGURE 3

Results of cumulative sum analysis of robotic living donor right hepatectomy. (A) Mobilization time, (B) parenchymal transection time.