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Ruff et al. Mini-invasive Surg 2024;8:12 https://dx.doi.org/10.20517/2574-1225.2024.39 Page 5 of 7

Table 1. Summary of critical components to building a robotic liver surgery program
Overcoming the ● Use an established curriculum that combines simulation, biotissue practice sessions, video review, intraoperative
learning curve feedback with experienced mentors, and quality assessments
● Start with simple cases and slowly increase the difficulty over time
Team dynamics ● Assemble a team with at least two surgeons with open liver experience, operating room staff (circulating nurses,
scrub nurses/technologists, residents, bedside first assistants), and anesthesia
● Provide in-service trainings for staff
● The same team should work together regularly for safety measures and to quickly resolve issues
● Support of hospital administration
Patient selection ● Hospital should be a high-volume hepatopancreatobiliary center with multidisciplinary tumor board
● Difficult cases with aberrant anatomy, vascular involvement, or that require more complex components (e.g., hilar
dissection) should be avoided in the beginning
● Patient factors such as history of multiple abdominal surgeries or severe co-morbidities should be taken into account
early in the learning curve
● Set a time limit for difficult components of the operation to ensure forward progress
● Quality assessments should be performed at regular intervals

DECLARATIONS
Authors’ contributions
Design, writing and editing of this manuscript: Ruff SM, Tsung A

Availability of data and materials
Not applicable

Financial support and sponsorship
None.

Conflicts of interest
Both authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2024.

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