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Transition from laparoscopic to robotic liver surgery: clinical outcomes, learning curve effect, and cost-effectiveness

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Abstract

The reproducibility of the implementation of robotic liver surgery (RLS) is still debated. The aim of the present study is to evaluate short-term outcomes and cost differences during the implementation of RLS, performed by an early adopter in laparoscopic liver surgery (LLS). Patients undergoing RLS between February 2020 and May 2021 were included. Short-term outcomes of the robotic group (RG) were compared to the “Initial Phase” group (IP) of 120 LLS cases and the 120 most recent laparoscopic cases or “Mastery Phase” group (MP). A cost analysis per procedure for the three groups was performed. Seventy-one patients underwent RLS during the study period. Median operative time in the RG was comparable to the IP, but significantly shorter in the MP (140 vs 138 vs 120 min, p < 0.001). Median intraoperative blood loss in the RG was lower than in both laparoscopic groups (40 ml [20–90 ml] vs 150 ml [50–250 ml] vs 80 ml [30–150 ml], p < 0.001). Median hospital stay in the RG was significantly shorter than the IP group (p < 0.001). There were no significant differences in postoperative complication, conversion, or readmission rates. Procedural cost analysis was in favor of robotic surgery (€5008) compared to the IP (€ 6913) and the MP (€6099). Surgeons with sufficient experience in LLS can rapidly overcome the learning curve for RLS. In our experience, the short-term outcomes of the implementation phase of RLS are similar to the mastery phase of LLS. The total average cost per procedure is lower for RLS compared to LLS.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Author notes

  1. M. D’Hondt and A. Devooght have shared first authorship.

Authors and Affiliations

  1. Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium

    M. D’Hondt, A. Devooght, E. Willems, C. De Meyere & A. Provoost

  2. Department of Abdominal Surgery, Hospital Oost-Limburg, Genk, Belgium

    D. Wicherts

  3. Department of Oncology and Statistics, Groeninge Hospital, Kortrijk, Belgium

    I. Parmentier

  4. Interdisciplinary Research Centre, Leuven University Campus Kortrijk, Kortrijk, Belgium

    H. Pottel

  5. Department of Gastroenterology and Hepatology, KU Leuven, Leuven, Belgium

    C. Verslype

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  1. M. D’Hondt
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Correspondence to M. D’Hondt.

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Approval was granted by the institution’s ethical committee (Commissie medische ethiek AZ Groeninge/B3962021000010).

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D’Hondt, M., Devooght, A., Willems, E. et al. Transition from laparoscopic to robotic liver surgery: clinical outcomes, learning curve effect, and cost-effectiveness. J Robotic Surg 17, 79–88 (2023). https://doi.org/10.1007/s11701-022-01405-w

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  • DOI: https://doi.org/10.1007/s11701-022-01405-w

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