Robot-assisted liver surgery in a general surgery unit with a "Referral Centre Hub&Spoke Learning Program". Early outcomes after our first 70 consecutive patients

Minerva Chir. 2018 Oct;73(5):460-468. doi: 10.23736/S0026-4733.18.07651-4. Epub 2018 May 24.


Background: The aim of this study was to evaluate safety, feasibility and short-term outcomes of our first 70 consecutive patients treated by robotic-assisted liver resection after a reversal proctoring between a high HPB volume centre and our well-trained center in minimally invasive General Surgery. Six surgeons were involved in this Hub&Spoke learning program.

Methods: From September 2012 to December 2016, 70 patients underwent robotic-assisted liver resections (RALR). We treated 18 patients affected by colorectal and gastric cancer with synchronous liver lesions suspected for metastases in a one-stage robotic-assisted procedure. For the first 20 procedures we had a tutor in the operatory room, who was present also in the next most difficult procedures.

Results: The 30- and 90-day mortality rate was zero with an overall morbidity rate of 10.1%. Associated surgical procedures were performed in about 65,7% of patients. The observed conversion rate was 10%. The results of the first 20 cases were similar to the next 50 showing a shortned learning curve.

Conclusions: Minimally invasive robot-assisted liver resection is a safe technique; it allows overcoming many limits of conventional laparoscopy. This innovative, time-enduring Hub&Spoke may allow patients to undergo a proper standard of care also for complex surgical procedures, without the need of reaching referral centres.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Feasibility Studies
  • Female
  • Hepatectomy / adverse effects
  • Hepatectomy / education
  • Hepatectomy / methods*
  • Humans
  • Liver Neoplasms / surgery*
  • Male
  • Middle Aged
  • Referral and Consultation
  • Retrospective Studies
  • Robotic Surgical Procedures* / adverse effects
  • Robotic Surgical Procedures* / education
  • Time Factors
  • Treatment Outcome