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

• Published in: Minerva chirurgica Vol. 73; no. 5; p. 460
• Main Authors: Ceccarelli, Graziano, Andolfi, Enrico, Fontani, Andrea, Calise, Fulvio, Rocca, Aldo, Giuliani, Antonio
• Format: Journal Article
• Language: English
• Published: Italy 01.10.2018
• Subjects: 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
• ISSN: 1827-1626
• DOI: 10.23736/S0026-4733.18.07651-4

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. 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. 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. 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.