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Mastering Robotic Liver Resection: When Access Defines Success - Insights from the French FRIES-ACHBPT-2024 Cohort
Raphael Venezia1, Guillaume Millet2, Stylianos Tzedakis3
1Université Paris-Est Créteil, UPEC, Créteil, France; INSERM, U955, Team "Virus Hépatologie Cancer", Créteil, France; Department of Digestive and Hepatobiliary Surgery, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France.
Annals of Surgery
|October 29, 2025
Summary
Frequent access to robotic liver resection (RLR) platforms enables surgeons to achieve proficiency faster and reduces complications. Weekly access is key for optimal RLR training and patient outcomes.
Area of Science:
- Hepatobiliary Surgery
- Minimally Invasive Surgery
- Surgical Robotics
Background:
- Robotic liver resection (RLR) offers advantages but is limited by restricted access to robotic platforms, hindering consistent learning.
- Understanding the impact of procedural frequency on RLR learning curves and outcomes is crucial for effective training and implementation.
Purpose of the Study:
- To evaluate the learning curve for robotic liver resection (RLR) in France.
- To determine how procedural frequency affects surgical performance (conversion rates) and postoperative outcomes (complications).
Main Methods:
- A retrospective multicenter cohort study (FRIES-ACHBPT-2024) analyzed 650 RLR cases from 10 French centers (2010-2024).
- Cumulative sum (CUSUM) analysis assessed learning curves for conversion and blood loss, stratified by complexity and procedural frequency (high: ≤7 days; low: >7 days).
- Multivariable logistic regression identified predictors of postoperative complications.
Main Results:
- The overall conversion rate was 10.8%; blood loss correlated with complexity (IMM grades 1-3).
- Learning curve inflection points were observed at 41 cases for conversion and 58 for blood loss.
- High-frequency RLR access (weekly) led to earlier competency (35 cases) compared to low-frequency access (47 cases). Predictors of complications included low-frequency access, older age, metabolic syndrome, larger tumors, higher complexity, and conversion.
Conclusions:
- Frequent access to robotic platforms (at least weekly) accelerates RLR proficiency and lowers complication rates.
- Structured training pathways and equitable access are vital for the safe and effective adoption of RLR.
