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Learning Curve of Robotic Liver Surgery: Preliminary Experience
Gaetano Piccolo1, Matteo Barabino1, Giampaolo Formisano1
1General Surgery Unit, Department of Health Sciences (DISS), San Paolo Hospital, University of Milan, Milan, Italy.
Surgical Innovation
|November 24, 2025
Summary
This study shows that robotic liver resection (RLR) is feasible for surgeons with limited laparoscopic experience. A multidisciplinary team approach facilitated the development of surgical skills and improved outcomes.
Area of Science:
- Hepatobiliary Surgery
- Minimally Invasive Surgery
- Robotic Surgery
Background:
- Robotic surgery adoption is increasing in general surgery centers with limited laparoscopic liver resection experience.
- This study details initial experiences with robotic liver resection (RLR).
Purpose of the Study:
- To evaluate the learning curve and feasibility of robotic liver resection (RLR) in a center with prior laparoscopic experience.
- To assess the impact of a multidisciplinary team approach on RLR outcomes.
Main Methods:
- Retrospective analysis of 61 consecutive minor RLRs performed between 2022 and 2024.
- Data collected included operative time and intraoperative blood loss to construct learning curves.
- Surgeons were assisted by an expert robotic colorectal team.
Main Results:
- Significant improvements in operative time and reduced blood loss were observed from the 14th case onwards.
- Operative time plateaued around the 41st case, and blood loss stabilized below 400 mL.
- Increased complexity (IWATE score) was managed effectively as surgical mastery progressed.
Conclusions:
- Robotic liver resection (RLR) is a viable option for centers transitioning from laparoscopic procedures.
- Continuous development and collaboration within a multidisciplinary team are crucial for successful RLR implementation.
- Technological advancements combined with team synergy drive successful robotic surgery programs.
