TY - JOUR
T1 - Implementation and Outcome of Robotic Liver Surgery in the Netherlands
T2 - A Nationwide Analysis
AU - Zwart, Maurice
AU - Görgec, Burak
AU - Nota, Carolijn L.
AU - Bijlstra, Okker D.
AU - Bosscha, Koop
AU - de Boer, Marieke T.
AU - de Wilde, Roeland F.
AU - Draaisma, Werner A.
AU - Gerhards, Michael F.
AU - Liem, Mike S.
AU - Lips, Daan J.
AU - Marsman, Hendrik A.
AU - Mieog, J. Sven D.
AU - Molenaar, Quintus I.
AU - Nijkamp, Maarten
AU - te Riele, Wouter W.
AU - Terkivatan, T. rkan
AU - Vahrmeijer, Alexander L.
AU - Besselink, Marc G.
AU - Dutch Liver Collaborative Group
AU - Swijnenburg, Rutger-Jan
AU - Hagendoorn, Jeroen
N1 - Publisher Copyright: © 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/6/1
Y1 - 2023/6/1
N2 - 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.
AB - 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.
KW - hepatic resection
KW - implementation; liver resection
KW - liver surgery
KW - minimally invasive liver resection; minimally invasive liver surgery
KW - nationwide analysis; robotic liver resection; robotic liver surgery
UR - http://www.scopus.com/inward/record.url?scp=85159567637&partnerID=8YFLogxK
U2 - https://doi.org/10.1097/SLA.0000000000005600
DO - https://doi.org/10.1097/SLA.0000000000005600
M3 - Article
C2 - 35848742
SN - 0003-4932
VL - 277
SP - E1269-E1277
JO - Annals of surgery
JF - Annals of surgery
IS - 6
ER -