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Published on: June 24, 2022
Learning Curves and Complexity Evolution in Robotic Liver Surgery: An International Multicenter Study with Comparison
Christoph Kuemmerli1, Gabriel F Hess1, Adrian T Billeter1
1Department of Surgery, Clarunis University Digestive Health Care Center, University Hospital Basel, Basel, Switzerland.
Annals of Surgery
|June 17, 2026
Summary
Robotic liver resection (RLR) demonstrates a learning curve with early competency achievement and stable outcomes across increasing complexity. Experienced centers can safely integrate RLR, highlighting its role in modern hepatobiliary surgery.
Area of Science:
- Minimally Invasive Surgery
- Surgical Oncology
- Hepatobiliary Surgery
Background:
- Robotic liver resection (RLR) adoption is growing globally.
- The learning curve and outcome impact of RLR are not well-defined.
Purpose of the Study:
- Evaluate the institutional learning curve of RLR.
- Assess RLR's association with surgical complexity and outcomes.
- Analyze RLR learning dynamics in an international multicenter cohort.
Main Methods:
- Retrospective cohort study of 2,331 RLR cases across 22 expert centers (06/2013-12/2024).
- Learning curve defined by operative time (competency), major complications (proficiency), and textbook outcome (mastery) within the first 150 cases per center.
- Risk-adjusted generalized additive models assessed learning; benchmark performance compared to international references.
Main Results:
- Operative time decreased significantly by case #62 (competency).
- Major morbidity plateaued during proficiency (cases #63-138), with improved textbook outcomes by mastery (cases #139-150).
- Conversion rates, bile leaks, and mortality remained low and stable; benchmark criteria met across complexity levels, even early in the learning phase.
Conclusions:
- Robotic liver surgery shows progressive outcome improvement.
- Benchmark-level results are achieved early, with stable performance despite increasing complexity.
- RLR can be safely implemented in experienced centers, supporting its role in hepatobiliary surgery.