{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:22:58Z","timestamp":1786116178282,"version":"build-2736575974"},"reference-count":35,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"European Union\u2014Next Generation EU\u2014NRRP M6C2\u2014Investment 2.1 Enhancement and strengthening of biomedical research in the NHS","award":["PNRR-MCNT1-2023-12378347"],"award-info":[{"award-number":["PNRR-MCNT1-2023-12378347"]}]},{"award":["PNRR-MCNT1-2023-12378347"],"award-info":[{"award-number":["PNRR-MCNT1-2023-12378347"]}],"id":[{"id":"https:\/\/ror.org\/019w4f821","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: The adoption of robotic surgery in minimally invasive liver surgery has accelerated globally in the last decade, yet its impact on clinical outcomes and the associated benefits remain to be explored. Methods: The study analyzed 8928 minimally invasive liver resections recorded in the I Go MILS registry between 2015 and 2025. Temporal trends in surgical approach, Pringle maneuver utilization, conversion to open surgery, and postoperative morbidity were assessed using Cochran\u2013Armitage and Spearman tests. Case-mix evolution was quantified by the Kawaguchi\u2013Gayet difficulty score. Results: Robotic utilization increased monotonically from 10.4% to 42.2%, while fully laparoscopic procedures declined from 89.6% to 57.8%. Despite this transition, aggregate conversion and morbidity showed no significant temporal trends. Stratified analysis demonstrated lower observed conversion rates in the robotic group and a progressively narrowing difference in morbidity. Overall case-mix complexity increased significantly, driven exclusively by the laparoscopic arm, while the robotic case mix remained structurally stable. Conclusions: Aggregate outcome stability during the robotic transition suggests progressive case-mix complexification rather than technological stagnation. The robotic platform seems to be associated with an apparent conversion advantage; its higher observed morbidity may be attributable to structural differences in operative difficulty. Robotics act not as a substitute for laparoscopy but as a complementary approach applied to more complex resections.<\/jats:p>","DOI":"10.3390\/cancers18152516","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T08:08:02Z","timestamp":1786003682000},"page":"2516","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Tracking Technological Change in Liver Surgery: Robotic Adoption and Case-Mix Evolution in the I Go MILS Registry"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-3490-4618","authenticated-orcid":false,"given":"Luca","family":"Ruotolo","sequence":"first","affiliation":[{"name":"Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1504-5810","authenticated-orcid":false,"given":"Alessandro","family":"Ferrero","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mauriziano Hospital, 10128 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6911-563X","authenticated-orcid":false,"given":"Andrea","family":"Ruzzenente","sequence":"additional","affiliation":[{"name":"Division of General and Hepatobiliary Surgery, Department of Surgery, Dentistry, Gynecology, and Pediatrics, G.B. Rossi University Hospital, University of Verona  l, 37134 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felice","family":"Giuliante","sequence":"additional","affiliation":[{"name":"Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCSS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Mazzaferro","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of HPB Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori Di Milano, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2310-0245","authenticated-orcid":false,"given":"Umberto","family":"Cillo","sequence":"additional","affiliation":[{"name":"Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padua, 35128 Padua, Italy"},{"name":"Hepato-Bilio-Pancreatic Surgery and Liver Transplantation Unit, Azienda Ospedale Universita Padova, 35128 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9684-8035","authenticated-orcid":false,"given":"Salvatore","family":"Gruttadauria","sequence":"additional","affiliation":[{"name":"Clinical Pharmacy Service, IRCCS ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), UPMC (University of Pittsburgh Medical Center), 90127 Palermo, Italy"},{"name":"Abdominal Surgery and Organ Transplantation Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), UPMC (University of Pittsburgh Medical Center), 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Di Benedetto","sequence":"additional","affiliation":[{"name":"Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University Hospital of Modena \u201cPoliclinico\u201d, University of Modena and Reggio Emilia, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4334-5167","authenticated-orcid":false,"given":"Giorgio","family":"Ercolani","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy"},{"name":"General and Oncology Surgery, Morgagni-Pierantoni Hospital, Ausl Romagna, Forl\u00ec 47121, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5862-6151","authenticated-orcid":false,"given":"Matteo","family":"Ravaioli","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy"},{"name":"Hepato-Biliary and Transplant Unit, IRCCS Azienda Ospedaliero<sans-serif>\u2013<\/sans-serif>Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe Maria","family":"Ettorre","sequence":"additional","affiliation":[{"name":"Department of Surgery, San Camillo Forlanini Hospital, 00152 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6252-573X","authenticated-orcid":false,"given":"Andrea","family":"Belli","sequence":"additional","affiliation":[{"name":"Department of Gastro-Hepato-Pancreato-Biliary Surgery, Istituto Nazionale Tumori, IRCCS-Fondazione \u201cG. Pascale\u201d, Via Mariano Semmola, 80131 Napoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Vennarecci","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary and Liver Transplantation Surgery, Azienda Ospedaliera di Rilievo Nazionale (A.O.R.N). Cardarelli, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaele","family":"Dalla Valle","sequence":"additional","affiliation":[{"name":"Hepatobiliary Surgery Unit, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elio","family":"Jovine","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy"},{"name":"Department of General Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8108-9064","authenticated-orcid":false,"given":"Francesca","family":"Ratti","sequence":"additional","affiliation":[{"name":"Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, Italy"},{"name":"Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20134 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the I Go MILS Collaborative Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"ref_1","first-page":"619","article-title":"Recommendations for laparoscopic liver resection: A report from the second international consensus conference held in Morioka","volume":"261","author":"Wakabayashi","year":"2015","journal-title":"Ann. 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