Defining Global Benchmarks for Robotic Liver Resections: An International Multicenter Study

Objective: This study aimed to establish global benchmark outcomes indicators for robotic liver resections (R-LR). Background: In recent years, minimally invasive liver resections and in particular R-LR has seen an increase in uptake in recent years. Although, benchmark outcomes have been recently established for laparoscopic (L) -LR, this has not been established for R-LR. Methods: This is a post hoc analysis of a multicenter database of 5,213 patients undergoing R-LR in 51 international centers between 2016 and 2022. Benchmark cutoffs for 16 outcome indicators of low-risk R-LR were established. The 75^th percentile of individual center medians for a given outcome indicator was set as the benchmark cutoff. Four procedures were selected for benchmarking: left lateral sectionectomy(LLS)/H23, left hepatectomy(LH)/H234±1, right hepatectomy(RH)/H5678±1 and right posterior sectionectomy/H67 (RPS). Results: There were 1,654 R-LR cases (528 LLS/H23, 432 LH/H234±1, 408 RH/H5678±1, 286 RPS/H67) performed in 24 expert centers, of which 518 (31.3%) R-LR cases qualified as low risk benchmark cases. Benchmark outcomes were established for R-LLS/H23, R-LH/ H234±1, R-RH/ H5678±1 and R-RPS/H67 for operation time (190, 323, 474, 413) min, open conversion rate (0.0, 0.0, 1.3, 0.0)%, estimated blood loss (100, 250, 600, 550) mls, blood transfusion rate (0.0,0.0, 20.0, 29.2)%, postoperative major morbidity (0.0,0.0, 20.9, 16.7)%, 90-day mortality (0.0, 0.0,0.0, 0.0)% and textbook outcome (12.5,24.3,0,0)%. Conclusions: The present study established the first global benchmark values for R-LR. It provided an up-to-date reference of best achievable outcomes for auditing and benchmarking.