Textbook outcomes for robotic liver resection: assessing relevant clinical variables

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).
• 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.