Background : Robotic liver surgery has shown an exponential growth worldwide. One of the remaining concerns about robotic surgery are its perceived higher costs. This study was undertaken to analyze outcomes and costs of a high-volume robotic liver surgery program.

Methods : With IRB approval, we followed 310 consecutive patients who underwent robotic hepatectomies at our institution. ‘Major resection’ was defined as resection of ≥3 Couinaud segments. Postoperative complications are noted if of Clavien-Dindo grade ≥III. Data are presented as median(mean±SD).tumo

Results : Patients were 64(62±13.9) years-old with a BMI of 28(29±6.5) kg/m2, a MELD score of 7(8±3.4): 55% were women, 53% had previous abdominal operation(s), 57% required major resections, and 63% of operations had IWATE score ≥7. Operative duration was 247(277±124.2) minutes and blood loss was 100(194±233.0) mL. There were 6 (2%) conversions to ‘open’ operations [because of bleeding (2), extensive adhesions (3), lack of progress (1)] and 2 (1%) intraoperative complications [bleeding (2)]. There was a 5% postoperative complication rate and a 2% 90-day mortality rate (exacerbation of comorbidities(2), respiratory failure(1), sepsis(1), and GI bleed). Length of hospital stay (LOS) was 4(4±3.7) days with 18% readmittance within 30-days. Total cost was $27,912(32,782±26,543.07) with variable cost being $17,792(20,651±17,151.30), fixed direct cost being $2,111(2,473±2,022.52), and fixed indirect cost being $7,723(9,580±8,162.43). Hospital remuneration was $19,102(38,975±39,362.11) per operation. the IVC liga

Conclusions : Patients were generally older overweight women who had undergone previous abdominal operations and required major hepatectomies. Conversions to ‘open’, complications, LOS, readmissions, and deaths were few/short. Profit averaged over $6,000 per patient. Robotic liver surgery is safe, efficacious, and profitable.w