Implementation of a Robotic Liver Surgery Program in a Large Municipal Hospital: A Propensity Score-Matched Analysis of Clinical, Economic, and Learning Curve Outcomes

Background: Evidence regarding implementation of robotic liver surgery outside academic centers remains limited. This study evaluated perioperative, economic, and learning-curve outcomes during implementation of robotic liver surgery in a municipal hospital. Methods: Consecutive liver resections performed between November 2023 and June 2025 were retrospectively analyzed from an institutional database using propensity score matching. Primary outcomes included Textbook Outcome (TO), major complications (Clavien–Dindo ≥ IIIa), operative duration, blood loss, and postoperative quality of life (QoL). Learning curves were analyzed using cumulative sum analysis adjusted for IWATE difficulty levels. An economic subgroup analysis evaluated cost components. Results: After matching, operative duration, TO, and major complications were similar between groups, whereas blood loss was significantly lower in the robotic group. Risk-adjusted learning curves demonstrated outcome-specific change-points, with the lowest TO rates observed at 8 cases and peak major complication rates at 29 cases. QoL did not differ between groups. Total costs were comparable. Conclusions: Implementation of robotic liver surgery was associated with lower blood loss, but no statistically significant differences in the other principal clinical outcomes, total costs, or QoL. Complexity-adjusted learning curves demonstrated multidimensional learning patterns with different breakpoints across evaluated outcomes.