Robotic liver surgery: a global snapshot. Results from an international survey

BACKGROUND: Robotic liver surgery has gradually increased within the realm of minimally invasive hepatobiliary surgery; nevertheless, worldwide adoption rates, educational systems, and thought processes are various. MATERIALS AND METHODS: An online worldwide survey was devised to collect data from hepatobiliary surgeons with experience or interests in robotic liver surgery. The design explores the use of robotic platforms, adoption rate, learning opportunities, learning curves, procedural options based on complexity, safety in perioperative phases, and limiting factors. Descriptive statistics are used to analyze the collected responses. RESULTS: The da Vinci platform is the most commonly used, while the new systems are still in the early adoption stages. Variability of use patterns has been identified. Structured learning, including simulation, proctoring, and learning at a second console, has been identified as essential to ensure safe adoption. The learning curve is a multi-step process that is dependent on procedure type, inherent surgical skills, and prior training. The laparoscopic, robotic, and open methods are considered to be relatively similar in low-complexity resections, while robotic, open, or a combination of robotic or open would be preferred for directing posterosuperior, major hepatectomy, as well as reconstruction cases, respectively. CONCLUSION: Robotic liver surgery is gradually being adopted within the realm of hepatobiliary surgery, but has been unevenly distributed. Uniform models of training, organizational structure, and equal availability of systems are essential factors that define how such systems are expanded.