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Updated: Jan 6, 2026
Robotic Left Hepatectomy using Indocyanine Green Fluorescence Imaging for an Intrahepatic Complex Biliary Cyst
Published on: June 24, 2022
Transforming robotic hepatectomy outcomes: a comparative analysis before and after ERAS protocol implementation
Kristina Milivojev Covilo1, Stella J Pagano1, Sharona B Ross1
1Director of Hepatobiliary and Robotic Liver Surgery Program, Codirector of Advanced Gastrointestinal and Hepatopancreatobiliary Fellowship, Division Chief of Hepatopancreatobiliary Surgery, Digestive Health Institute of AdventHealth Tampa, Hepatopancreatobiliary (HPB) and Robotic Surgery, 3000 Medical Park Drive, Suite # 500, Tampa, FL, 33613, USA.
Implementing the Enhanced Recovery After Surgery (ERAS) protocol alongside robotic hepatectomy significantly improved patient outcomes. This approach reduced blood loss and lowered 90-day readmission rates in liver resection patients.
Area of Science:
- Hepatobiliary Surgery
- Minimally Invasive Surgery
- Surgical Outcomes
Background:
- The Enhanced Recovery After Surgery (ERAS) protocol optimizes perioperative care, improving patient recovery and organizational efficiency.
- Robotic technology offers benefits in complex surgeries, including hepatobiliary resections.
- Integrating ERAS with robotic procedures may further enhance surgical outcomes.
Purpose of the Study:
- To compare perioperative outcomes of robotic hepatectomy performed before and after the implementation of the ERAS protocol.
- To evaluate the impact of ERAS protocol on blood loss and readmission rates in robotic liver resections.
Main Methods:
- Retrospective analysis of 544 patients undergoing robotic liver resection (2013-2024), excluding the initial 65 patients to mitigate learning curve effects.
- Patients were divided into pre-ERAS and post-ERAS groups.
- Propensity score matching (1:2) was used based on patient demographics, tumor characteristics, and resection extent.
Main Results:
- The post-ERAS group showed a significant decrease in estimated blood loss (EBL) compared to the pre-ERAS group (141.7 ± 151.5 mL vs. 214.7 ± 250.9 mL).
- A notable reduction in the 90-day readmission rate was observed in the post-ERAS group (13.4% vs. 22.6%).
- Demographic differences included higher rates of coronary artery disease and hypertension in the post-ERAS group, and heart disease in the pre-ERAS group.
Conclusions:
- Implementation of the ERAS protocol in conjunction with robotic hepatectomy leads to improved perioperative outcomes.
- This combined approach results in reduced blood loss and fewer 90-day readmissions following liver resection.
- The findings support the integration of ERAS protocols to optimize robotic liver surgery.
