Objective: This study aimed to establish global benchmark outcomes indicators for robotic liver resections (R-LR). Background: In recent years, minimally invasive liver resections and in particular R-LR has seen an increase in uptake in recent years. Although, benchmark outcomes have been recently established for laparoscopic (L) -LR, this has not been established for R-LR. Methods: This is a post hoc analysis of a multicenter database of 5,213 patients undergoing R-LR in 51 international centers between 2016 and 2022. Benchmark cutoffs for 16 outcome indicators of low-risk R-LR were established. The 75th percentile of individual center medians for a given outcome indicator was set as the benchmark cutoff. Four procedures were selected for benchmarking: left lateral sectionectomy(LLS)/H23, left hepatectomy(LH)/H234±1, right hepatectomy(RH)/H5678±1 and right posterior sectionectomy/H67 (RPS). Results: There were 1,654 R-LR cases (528 LLS/H23, 432 LH/H234±1, 408 RH/H5678±1, 286 RPS/H67) performed in 24 expert centers, of which 518 (31.3%) R-LR cases qualified as low risk benchmark cases. Benchmark outcomes were established for R-LLS/H23, R-LH/ H234±1, R-RH/ H5678±1 and R-RPS/H67 for operation time (190, 323, 474, 413) min, open conversion rate (0.0, 0.0, 1.3, 0.0)%, estimated blood loss (100, 250, 600, 550) mls, blood transfusion rate (0.0,0.0, 20.0, 29.2)%, postoperative major morbidity (0.0,0.0, 20.9, 16.7)%, 90-day mortality (0.0, 0.0,0.0, 0.0)% and textbook outcome (12.5,24.3,0,0)%. Conclusions: The present study established the first global benchmark values for R-LR. It provided an up-to-date reference of best achievable outcomes for auditing and benchmarking.
Defining Global Benchmarks for Robotic Liver Resections: An International Multicenter Study / Goh, B. K. P.; Sucandy, I.; Chua, D. W.; Liu, Q.; Edwin, B.; Aghayan, D.; Millet, G.; Ratti, F.; Zhang, W.; Scatton, O.; Coelho, F. F.; Dokmak, S.; Mazzaferro, V.; Chiow, A. K. H.; Primavesi, F.; Ivanecz, A.; Choi, S. -H.; Lee, J. H.; Prieto, M.; Vivarelli, M.; Giuliante, F.; Ruzzenente, A.; Yong, C. -C.; Yin, M.; Fondevila, C.; Efanov, M.; Morise, Z.; Di Benedetto, F.; Brustia, R.; Valle, R. D.; Boggi, U.; Geller, D.; Belli, A.; Memeo, R.; Hasegawa, K.; Croner, R. S.; Gruttadauria, S.; Hawksworth, J.; Park, J. O.; Rotellar, F.; Choi, G. -H.; Robles-Campos, R.; Wang, X.; Sutcliffe, R. P.; Krenzien, F.; Pratschke, J.; Lai, E. C. H.; Chong, C. C. N.; Ishizawa, T.; Monden, K.; Lopez-Ben, S.; Kingham, T. P.; Ferrero, A.; Ettorre, G. M.; Liang, X.; Mejia, A.; Marino, M. V.; Swijnenburg, R. -J.; Wakabayashi, G.; Troisi, R. I.; Cheung, T. -T.; Sugioka, A.; Sugimoto, M.; Labgaa, I.; Schmelzle, M.; Hatano, E.; Cillo, U.; Long, T. C. D.; Peng, Y.; Wei, Y.; Yong, Z.; El Adel, S.; Han, H. -S.; Soubrane, O.; Fuks, D.; Chen, K. -H.; D'Hondt, M.; Abu Hilal, M.; Aldrighetti, L.; Liu, R.; Gastaca, M.; De Meyere, C.; Chaoui, I.; Lee, K. -F.; Chok, K.; Tarakanov, P.; Koroleva, A.; Thiruchelvam, N.; Jang, J. Y.; Kojima, M.; Kato, Y.; Herman, P.; Kruger, J. A. P.; Lopez-Lopez, V.; Casellas I Robert, M.; Rompianesi, G.; Giglio, M.; D'Silva, M.; Lee, B.; Wang, H. -P.; Cherqui, D.; Pascual, F.; Saleh, M.; Ghallab, M.; Halim, N. A.; Chen, Z.; Yu, S.; Vani, S.; Ardito, F.; Famularo, S.; Giustizieri, U.; Citterio, D.; Mocchegiani, F.; Berardi, G.; Colasanti, M.; Guzman, Y.; Labadie, K. P.; Goodsell, K.; Conticchio, M.; Dogeas, E.; Kauffmann, E. F.; Giuffrida, M.; Sommacale, D.; Laurent, A.; Magistri, P.; Mishima, K.; Kadam, P.; Tang, C. N.; Forchino, F.; Valle, B. D.; Cauchy, F.; Karam, E.; Mazzotta, A.; Zheng, J.; Nghia, P. P.; Lim, C.; Da Cunha, G. P.; Besselink, M. G.; Liu, F.; Li, B.; Kawaguchi, Y.; Rahimli, M.; Barbara, M.; Pagano, D.; Cipriani, F.; Liu, Q.; Siow, T. -F.; Gaetan-Romain, J.; Demartines, N.; Iwaki, K.; Ogiso, S.; Lanari, J.; Nevermann, N.; Staettner, S.; Shen, W. -B.; Ghotbi, J.; Fretland, A. A.. - In: ANNALS OF SURGERY. - ISSN 0003-4932. - (2025), pp. 1-54. [10.1097/SLA.0000000000006852]
Defining Global Benchmarks for Robotic Liver Resections: An International Multicenter Study
Di Benedetto F.;Magistri P.;
2025
Abstract
Objective: This study aimed to establish global benchmark outcomes indicators for robotic liver resections (R-LR). Background: In recent years, minimally invasive liver resections and in particular R-LR has seen an increase in uptake in recent years. Although, benchmark outcomes have been recently established for laparoscopic (L) -LR, this has not been established for R-LR. Methods: This is a post hoc analysis of a multicenter database of 5,213 patients undergoing R-LR in 51 international centers between 2016 and 2022. Benchmark cutoffs for 16 outcome indicators of low-risk R-LR were established. The 75th percentile of individual center medians for a given outcome indicator was set as the benchmark cutoff. Four procedures were selected for benchmarking: left lateral sectionectomy(LLS)/H23, left hepatectomy(LH)/H234±1, right hepatectomy(RH)/H5678±1 and right posterior sectionectomy/H67 (RPS). Results: There were 1,654 R-LR cases (528 LLS/H23, 432 LH/H234±1, 408 RH/H5678±1, 286 RPS/H67) performed in 24 expert centers, of which 518 (31.3%) R-LR cases qualified as low risk benchmark cases. Benchmark outcomes were established for R-LLS/H23, R-LH/ H234±1, R-RH/ H5678±1 and R-RPS/H67 for operation time (190, 323, 474, 413) min, open conversion rate (0.0, 0.0, 1.3, 0.0)%, estimated blood loss (100, 250, 600, 550) mls, blood transfusion rate (0.0,0.0, 20.0, 29.2)%, postoperative major morbidity (0.0,0.0, 20.9, 16.7)%, 90-day mortality (0.0, 0.0,0.0, 0.0)% and textbook outcome (12.5,24.3,0,0)%. Conclusions: The present study established the first global benchmark values for R-LR. It provided an up-to-date reference of best achievable outcomes for auditing and benchmarking.
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