{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:51:59Z","timestamp":1787755919512,"version":"build-2784847793"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"National Hospital"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Endosc"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Textbook outcome (TO) provides a patient-centered composite measure of perioperative quality in liver surgery. Although robotic liver surgery (RLS) is increasingly adopted, data applying internationally harmonized TO definitions to RLS remain limited, particularly when interpreted according to procedural difficulty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We reviewed 200 consecutively performed RLSs at a high-volume hepatopancreatobiliary center in Denmark. TO after RLS (TORLS) was assessed by applying the internationally established Delphi consensus definition of textbook outcome in liver surgery to the RLS cohort. For clarity, this endpoint is referred to descriptively as TORLS, although no new robotic-specific textbook outcome definition was created. The components were: no intraoperative incident grade\u2009\u2265\u20092 (modified Oslo classification), no bile leakage grade B\/C, no post-hepatectomy liver failure grade B\/C, no Clavien\u2013Dindo grade\u2009\u2265\u2009III complications within 90 days, no surgery-related (Clavien\u2013Dindo grade\u2009\u2265\u2009III) readmission within 90 days, no in-hospital\/90-day mortality, and R0 resection (malignant tumors; resection margin\u2009\u2265\u20091mm). TORLS\u2009+\u2009additionally required no occurrence of prolonged hospitalization (over 3 days for minor resection, over 5 days for major resection). Surgical difficulty was assessed using the IWATE criteria and classified dichotomously (\u2264\u20096 vs\u2009\u2265\u20097).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 210 RLS cases assessed, 10 were excluded: safety-driven change in operative strategy after intraoperative liver assessment (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20095) and missing data required to adjudicate TORLS components and\/or 90-day follow-up (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20095). The analysis included 200 cases (IWATE\u2009\u2264\u20096: 123 cases, IWATE\u2009\u2265\u20097: 77 cases). Overall, TORLS was achieved in 155\/200 (77.5%) cases, and TORLS+\u2009was achieved in 119\/200 (59.5%) cases. TORLS was achieved in 100\/123 (81.3%) cases in the IWATE\u2009\u2264\u20096 group and in 55\/77 (71.4%) cases in the IWATE\u2009\u2265\u20097 group. TORLS+\u2009achievement rates were 78\/123 (63.4%) and 41\/77 (53.2%), respectively. The most frequent limiting factor was prolonged hospitalization.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this single-center Danish cohort of 200 RLS cases, TORLS and TORLS+\u2009achievement rates were numerically lower in procedures with higher IWATE difficulty scores; these differences did not reach statistical significance. Consensus-based TO assessment after RLS was feasible and may provide difficulty-stratified institutional reference values for internal quality monitoring.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00464-026-13142-4","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:11:39Z","timestamp":1787753499000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Textbook outcome after robotic liver surgery at a high-volume Scandinavian HPB center: an IWATE-based difficulty-stratified assessment of 200 cases"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8747-8864","authenticated-orcid":false,"given":"Daisuke","family":"Fukumori","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Tschuor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Hamada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Hillings\u00f8","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter N\u00f8rgaard","family":"Larsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"issue":"8","key":"13142_CR1","doi-asserted-by":"publisher","first-page":"e212064","DOI":"10.1001\/jamasurg.2021.2064","volume":"156","author":"B G\u00f6rgec","year":"2021","unstructured":"G\u00f6rgec B et al (2021) Assessment of textbook outcome in laparoscopic and open liver surgery. 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Daisuke Fukumori, Christoph Tschuor, Takashi Hamada, Jens Hillings\u00f8, and Peter N\u00f8rgaard Larsen have no conflicts of interest or financial ties to disclose.","order":1,"name":"Ethics","label":"Disclosures","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"According to the Danish Law of Health, this retrospective quality-control study using anonymized routinely collected clinical data did not require formal ethical committee approval. Therefore, the study was not formally reviewed by an IRB or ethics committee, no separate official waiver was obtained, and no waiver or reference number is available.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Patient informed consent was not required because only anonymized routinely collected clinical data were used.","order":3,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}}]}}