title: Robotic major hepatectomy: Is there a learning curve?
abstract: Robotic hepatectomy has been suggested as a safe and effective management of liver disease. However, no large case series have documented the learning curve for robotic major hepatectomy.
  
  
  
  We conducted a retrospective study for robotic major hepatectomy performed by the same operative team between January 2012 and October 2015 and evaluated the learning curve for operation time using the cumulative sum method, presented as cumulative sumoperation time.
  
  
  
  Overall, there were 183 robotic hepatectomies, 92 of which were performed in patients who underwent robotic major hepatectomy: left hemihepatectomy was performed in 32 (34.8%) patients, right hemihepatectomy in 41 (44.6%), left trisectionectomy in 3 (3.3%), right trisectionectomy in 6 (6.5%), and 8-5-4 trisegmentectomy in 10 (10.8%). The median duration of surgery was 434 minutes (142-805 minutes) and the median blood loss was 195 mL (50-2,000 mL). Fifty-nine percent of patients had malignancies, and those with advanced stages of cancer had more blood loss during an operation. The cumulative sumoperation timemodel of robotic major hepatectomy suggested that the learning curve comprised 3 characteristic phases: initial (phase 1, 15 patients), intermediate (phase 2, 25 patients), and mature (phase 3, 52 patients). The learning effects were underlined by shorter operation time and hospital stay after phase 1 and less blood loss after phase 2.
  
  
  
  This is the largest series regarding robotic major hepatectomy. Our findings suggest that a solid training program based on the learning curve should be considered for beginners of robotic hepatectomy. Participants should evaluate the evolution of our minimally invasive hepatectomy before considering our robotic experience.
authors.affiliation: Department of Surgery, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Po-Da
authors.initials: PD
authors.lastname: Chen
authors.affiliation: Department of Surgery, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chao-Yin
authors.initials: CY
authors.lastname: Wu
authors.affiliation: Department of Surgery, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Rey-Heng
authors.initials: RH
authors.lastname: Hu
authors.affiliation: Department of Surgery, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chiung-Nien
authors.initials: CN
authors.lastname: Chen
authors.affiliation: Department of Surgery, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Ray-Hwang
authors.initials: RH
authors.lastname: Yuan
authors.affiliation: Department of Surgery, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Jin-Tung
authors.initials: JT
authors.lastname: Liang
authors.affiliation: Department of Surgery, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Hong-Shiee
authors.initials: HS
authors.lastname: Lai
authors.affiliation: Department of Surgery, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan. Electronic address: wyaoming@gmail.com.
authors.forename: Yao-Ming
authors.initials: YM
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000193:education*; D006801:Humans; D059032:Learning Curve; D007902:Length of Stay; D008107:Liver Diseases / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000193:education*; D016896:Treatment Outcome; D055815:Young Adult