Citations 2
Learning Curves and Complexity Evolution in Robotic Liver Surgery
Kuemmerli, Christoph , Hess, Gabriel Fridolin , Billeter, Adrian T. , Benedetto, Fabrizio Di , Odorizzi, Roberta, Sucandy, Iswanto , Aegerter, Noa L. E., Berchtold, Caroline , Bernardi, L. , Cristaudi, Alessandra , Balzano, E , Koh, Ye-Xin, Lin, Charles Chung-Wei, Fukumori, Daisuke , Tschuor, Christoph , White, Steve, Kroge, P Von, Heumann, Asmus , Meyere, Céline De, D’hondt, M, Haak, Fabian, Stättner, Stefan, Primavesi, Florian, Morgül, Haluk , Andreou, A, Ratti, F, Esquer, Ignacio Sánchez, Robles-Campos, Ricardo, Lopez-Lopez, Victor, Wakabayashi, Go , Nebbia, Martina, Rahbari, Nuh N., Ferretti, Stefano, Ettore, Giuseppe , Croner, RS , Dong, Y, Starlinger, P, Nickel, F, Müller, Beat P., Hess, Gabriel F , Guidetti, Cristiano , di Benedetto, Fabrizio , Sucandy, Iswanto , Aegerter, Noa L E , Berchtold, Caroline , Bernardi, Lorenzo , Cristaudi, Alessandra , Balzano, Emanuele , Ghinolfi, Davide , Goh, Brian K P , Fukumori, Daisuke , Tschuor, Christoph , Pandanaboyana, Sanjay , De Meyere, Celine , Seehofer, Daniel , Esquer, Ignacio Sánchez , Müller, Philip C , Koh, Ye-Xin , Lin, Charles Chung-Wei, Tschuor, Christoph , Kroge, Philipp H. von , D’Hondt, Mathieu , Haak, Fabian , Stättner, Stefan , Primavesi, Florian , Ratti, Francesca , Robles-Campos, Ricardo, López‐López, Víctor , Wakabayashi, Taiga , Nebbia, Martina , Gilg, Stefan , Birgin, Emrullah , Ferretti, Stefano , Ettore, Giuseppe Maria, Rahimli, Mirhasan , Nickel, Felix , Müller-Stich, Beat Peter
Annals of Surgery | June 17, 2026 | Volume: No volume available | Issue: No issue available | Pages: No page available
Objective: To evaluate the institutional learning curve of robotic liver resection (RLR), its association with surgical complexity and outcomes in an international multicenter cohort. Summary of Background Data: RLR is increasingly adopted worldwide, but the dynamics of the learning process and its impact on surgical outcomes remain poorly defined. Methods: This international, multicenter, retrospective cohort study included consecutive patients who underwent RLR between 06/2013 and 12/2024 across 22 expert centers. Based on the first 150 cases at each center, three phases were used to define the learning curve: operative time for competency, major complications for proficiency, and textbook outcome for mastery. Risk-adjusted generalized additive models were used to assess the learning process. Benchmark performance was compared to international reference values. Results: Among 2,331 patients, the most common indications were hepatocellular carcinoma (36%), benign lesions (23%) and colorectal liver metastases (21%). Operative time decreased after achieving competency (case #62), from 240 to 220 minutes ( P <0.001). Major morbidity reached a plateau during the proficiency phase (cases #63–138; 9% vs. 11%, P =0.144), while progression to mastery (cases #139–150) was associated with a higher rate of textbook outcome (76% vs. 87%, P =0.021). In contrast, conversion (5.1% vs. 4.9% vs. 2%), bile leak (4.0% vs. 5.3% vs. 3.8%), and 90-day mortality (0.7% vs. 0.9% vs. 0.9%) remained low and stable across all learning phases. Importantly, benchmark criteria for operative time, hospital stay, and textbook outcome were met across all complexity groups, including during the early learning phase. Conclusions: Robotic liver surgery shows progressive outcome improvement with early achievement of benchmark-level results and stable performance across increasing complexity. These findings indicate that, in experienced centers, RLR can be safely implemented and integrated into clinical practice, supporting its key role in modern hepatobiliary surgery.
International Reference Values for Surgical Outcomes of Total Pancreatectomy
Berchtold, Caroline , Kuemmerli, Christoph, Li, Zhihao , Eden, Janina , Wu, Pengfei , Cecchetto, Sara Nicole, Kendrick, Michael L. , Pecorelli, Nicolò , Guarneri, Giovanni , Farooqui, Waqas , Tschuor, Christoph , Burgdorf, Stefan Kobbelgaard , Mühlhäusser, Julia , Gass, Jörn‐Markus , Koh, Ye-Xin, Seip, Tomas, Santibañes, Martín de , Todeschini, Letizia , Marchegiani, Giovanni, Belfil, Nadiya , Boggi, Ugo, Cappelle, Marie , Koerkamp, Bas Groot , Dutkowski, Philipp , Hackert, Thilo , Truty, Mark J. , Group, Outcomes for Total Pancreatectomy, Valle, Valentina , Giulianotti, Pier Cristoforo , Pessaux, Patrick, Thapa, Prabin , Kuzman, Matta , Pandanaboyana, Sanjay, He, Jin , Kendrick, Michael, Truty, Mark, Li, Zhihao , Groot Koerkamp, Bas , Müller, Philip C , Breuer, Eva , Vallorani, Alessia , Hansen, Carsten Palnæs , Guidetti, Cristiano , Campbell, Brady A. , Cecchetto, Sara Nicole, Gudmundsdottir, Hallbera , Starlinger, Patrick , Goh, Brian K P , Koh, Ye-Xin , Rebelo, Artur , Kleeff, Jorg H. , Marchegiani, Giovanni , Lesurtel, Mickaël , Machado, Marcel Autran C. , Kauffmann, Emanuele F. , Benedetto, Fabrizio Di , Roberts, Keith John , Nevler, Avinoam , Lavu, Harish , Nickel, Felix , He, Jing , Falconi, Massimo , Billeter, Adrian T. , Müller-Stich, Beat Peter , Group, Outcomes for Total Pancreatectomy, Halle-Smith, James Michael , Giannone, Fabio , Pessaux, Patrick , Sánchez‐Velázquez, Patricia , Maharjan, Dhiresh Kumar , Torres, Orlando Jorge Martins
JAMA Surgery | November 12, 2025 | Volume: 161 | Issue: 1 | Pages: 50
Importance Total pancreatectomy (TP) is indicated for advanced pancreatic cancer or multifocal tumors. Furthermore, TP may be performed to avoid the risk of pancreatic fistula in selected patients to improve the perioperative risk profile. Objective To define reference values for TP based on a low-risk cohort treated at expert centers. Design, Setting, and Participants This multicenter study analyzed outcomes from patients undergoing primary TP for malignant or benign lesions from 25 international expert centers from January 2017 to November 2023. Low-risk patients undergoing TP (LR-TP) were without vascular resections or significant comorbidities. Exposures TP. Main Outcomes and Measures Twenty reference values were derived from the 75th or the 25th percentile of the median values of all centers. Outcomes of LR-TP were compared with a cohort of TP with vascular resection, TP due to high-risk pancreatic anastomosis, and the benchmark values for low-risk pancreatoduodenectomy. Results Of 994 patients, 333 (33.5%; median [IQR] age, 66 [58-72] years; 171 male [51.4%]) qualified as the LR-TP cohort. Reference values included blood loss (≤1000 mL), major complications (≤37%), 3-month postoperative mortality (&lt;6%), and retrieved lymph nodes (≥29). Compared with TP with vascular resections, reference cutoffs were not met for major complications (51% vs LR-TP ≤37%) and 90-day mortality (11% vs LR-TP ≤6%). For TP due to high-risk anastomosis, failure to rescue rate (38% vs ≤6%) and 90-day mortality (11% vs LR-TP ≤6%) were not met. Compared with pancreatoduodenectomy, reference values for postoperative mortality were 3 times higher for LR-TP (≤2% vs ≤6%) and less for resected lymph nodes (≥16 vs ≥29). Conclusions and Relevance This case-control study provided global reference values for TP, indicating significantly higher postoperative morbidity and mortality compared with pancreatoduodenectomy. Perioperative morbidity of TP was especially increased in patients with vascular resections. These reference values can serve for quality control of pancreatic surgery.