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Updated: Apr 21, 2026

Robotic Left Hepatectomy using Indocyanine Green Fluorescence Imaging for an Intrahepatic Complex Biliary Cyst
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Textbook outcomes for robotic liver resection: assessing relevant clinical variables.

E Giuseppe1, M C Kristina1, R Sharona1

  • 1Digestive Health Institute, AdventHealth Tampa, Tampa, FL, USA.

HPB : the Official Journal of the International Hepato Pancreato Biliary Association
|April 19, 2026
PubMed
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Robotic liver resections (LR) demonstrate high textbook outcome (TO) and extended-TO (TOLS+) rates. Achieving TO in robotic LR is linked to better perioperative factors, highlighting platform benefits in high-volume centers.

Area of Science:

  • Hepatobiliary Surgery
  • Minimally Invasive Surgery
  • Surgical Outcomes Research

Background:

  • Textbook outcome (TO) is a composite metric for surgical success, with established definitions for open and laparoscopic liver resections (LR).
  • Consensus on TO definitions for robotic LR is lacking.
  • This study evaluates TO and extended-TO (TOLS+) in robotic LR and identifies predictors of TO achievement.

Purpose of the Study:

  • To assess the achievement rates of Textbook Outcome (TO) and extended-TO (TOLS+) in patients undergoing robotic liver resections (LR).
  • To explore perioperative factors associated with achieving TO in robotic LR.
  • To establish consensus-based TO definitions for robotic LR.

Main Methods:

  • Retrospective analysis of 622 consecutive robotic LR cases (2013-2024).
Keywords:
Minimally invasive liver surgeryPerioperative outcomesQuality metricsRobotic liver resectionTextbook outcome

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  • TO and TOLS+ defined by a 2023 global expert Delphi consensus.
  • Logistic regression used to identify predictors of TO achievement.

    • Main Results:

    • Of 546 patients, 89.4% achieved TO and 65.6% met TOLS+ criteria.
    • Non-TO patients had longer operative times, higher blood loss, and increased rates of conversion and ICU admission.
    • TO achievement was significantly associated with a history of myocardial infarction, ICU admission, and prolonged length of stay (LOS).

    Conclusions:

    • Robotic liver resections (LR) demonstrated high rates of Textbook Outcome (TO) and extended-TO (TOLS+) in this cohort.
    • These findings support the efficacy of robotic platforms in achieving optimal surgical outcomes within high-volume centers.
    • Further research may refine TO criteria for robotic surgery.