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Background A paucity of data exists on the national use of robotic hepatectomy. We assessed national trends and perioperative outcomes of robotic hepatectomy in the USA. In addition, factors associated with use of the robotic approach were analyzed. Methods The National Cancer Database (NCDB) was queried for patients undergoing hepatectomy from 2010 to 2016. Patients undergoing total hepatectomy for transplant were excluded. Factors associated with the use of the robotic approach were assessed using logistic regression multivariable analysis. Propensity‐score analysis was performed (robotic vs. laparoscopic and robotic vs. open approaches), and perioperative outcomes were compared between the matched groups. Results The robotic approach was used in 287 patients (110 hospitals). Utilization of the robotic approach increased significantly on the national level from 0.8% in 2010 to 4.1% in 2016 (P<0.001). The number of hospitals performing a minimum of one robotic hepatectomy per year increased from 8 in 2010 to 35 in 2016. The median hospital length of stay was 4 days (IQR 3–6), 30‐day readmission rate was 5%, and 30‐day/90‐day mortality rates were 3%/4%. Factors associated with using robotic approach were African‐American race (95% CI 1.02–2.11), recent year of surgery (95% CI 1.11–1.32), HCC histology (95% CI 1.01–52.03), tumor size (95% CI 0.87–0.96), and early‐stage tumor (Stage I‐II, 95% CI 1.27–3.99). On propensity‐matched analysis, there were no differences between robotic and open approaches (n=184 each group) in 30‐day readmission (5% vs. 7%, P=0.651), 30‐day mortality (2% vs. 4%, P=0.106), 90‐day mortality (3% vs. 7%, P=0.080), or 5‐year overall survival (58% vs. 43%, P=0.211). However, the robotic approach was associated with a significantly shorter hospital stay (median: 4 vs. 6 days, P<0.001). There were no differences between matched groups of patients undergoing robotic and laparoscopic approaches (n=182 in each group) in perioperative outcomes or length of hospital stay. Conclusion National use of robotic‐assisted hepatectomy has increased by fivefold over the seven‐year study period. It was associated with a shorter hospital length of stay compared to the open approach without compromising perioperative outcomes or survival.

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In 2009, the Association of Academic Chairmen of Plastic Surgery, now known as the American Council of Academic Plastic Surgeons (ACAPS), published a white paper endorsing the conversion of plastic surgery divisions into autonomous departments, motioning for other national organizations to follow suit. ACAPS’ rationale outlined 11 factors intended to promote the favorability of attaining departmental status within an institution. Through surveying division chiefs turned founding department chairs who successfully executed this transition, we evaluate the practicality and efficacy of these guidelines. A survey was distributed to founding chairs of plastic surgery departments that were established after ACAPS’ 2009 white paper. Information pertaining to institutions’ demographic information and respondents’ utilization of the principles and suggestions espoused in the white paper was obtained. The survey achieved an 86% response rate. The average time needed for the transition was 22 ± 12 months. Four of seven chairs were familiar with the 2009 ACAPS white paper. Garnering support from hospital administrators and institutional stakeholders, having fiscal profitability within the institution, and coordinating an integrated plastic surgery training program were ranked as the top three most important factors, respectively. This study assesses ACAPS’ recommendations on transitioning from a division to a department on the basis of perceived utility by academic leaders who recently navigated the process. The most frequently cited factors for a successful transition included rallying support from institutional stakeholders and ensuring profitability. Additionally, aligning the timing with a concurrent transition of leadership can expedite the process.

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