Learning curve in robotic liver surgery: easily achievable, evolving from laparoscopic background and team-based

Background: Limited and heterogeneous literature data necessitate a focused examination of the learning curve in robotic liver resections. This study aims to assess the learning curve of two surgeons from the same team with differing laparoscopic backgrounds. Methods: Since February 2021, San Raffaele Hospital in Milan has implemented a robotic liver surgery program, performing 250 resections by three trained console surgeons. Using cumulative sum (CUSUM) analysis, the learning curve was evaluated for a Pioneer Surgeon (PS) with around 1200 laparoscopic cases and a New Generation Surgeon (NGS) with approximately 100 laparoscopic cases. Cases were stratified by complexity (38 low, 74 intermediate, 85 high). Results: Both PS and NGS demonstrated a learning curve for operative time after 15 low-complexity and 10 intermediate-complexity cases, with high-complexity learning curves apparent after 10 cases for PS and 18 cases for NGS. Conversion rates remained unaffected, and neither surgeon experienced increased blood loss or postoperative complications. A “team learning curve” effect in terms of operative time emerged after 12 cases, suggesting the importance of a cohesive surgical team. Conclusion: The robotic platform facilitated a relatively brief learning curve for low and intermediate complexity cases, irrespective of laparoscopic background, underscoring the benefits of team collaboration.