Tracking Technological Change in Liver Surgery: Robotic Adoption and Case-Mix Evolution in the I Go MILS Registry

Area of Science:

• Hepatobiliary Surgery
• Minimally Invasive Surgery
• Surgical Robotics

Background:

• Robotic surgery adoption in minimally invasive liver surgery has rapidly increased globally.
• The impact of robotic surgery on clinical outcomes and benefits requires further investigation.

Purpose of the Study:

• To analyze temporal trends in minimally invasive liver resections.
• To evaluate the impact of increasing robotic surgery utilization on conversion rates and postoperative morbidity.
• To assess changes in case-mix complexity during the transition to robotic platforms.

Main Methods:

• Analysis of 8928 minimally invasive liver resections from the I Go MILS registry (2015-2025).
• Assessment of temporal trends using Cochran-Armitage and Spearman tests.
• Quantification of case-mix complexity using the Kawaguchi-Gayet difficulty score.

Main Results:

• Robotic utilization rose from 10.4% to 42.2%, while laparoscopic procedures decreased.
• Aggregate conversion and morbidity rates showed no significant temporal trends.
• Robotic surgery was associated with lower conversion rates and stable, albeit higher, morbidity compared to laparoscopy, with increasing laparoscopic case complexity.

Conclusions:

• Overall outcome stability suggests case-mix complexification, not technological stagnation.
• Robotic platforms offer a conversion advantage and complement laparoscopy for complex liver resections.
• Observed higher morbidity in robotics may relate to operative difficulty, not inherent platform inferiority.