Comprehensive analysis of laparoscopic, robotic, and open hepatectomy outcomes using the nationwide readmissions database

Aziz, Hassan; Wang, Johnny C; Genyk, Yuri; Sheikh, Mohd Raashid

doi:10.1007/s11701-021-01257-w

Cited by 15 publications

(9 citation statements)

References 20 publications

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“…The conversion rate in the current study for all MIS liver resections (3.6%) was favorable and in line with previous large retrospective cohort studies [ 19 , 46 , 48 , 49 ]. In addition, acceptable rates of major morbidity and mortality after laparoscopic and robotic MIS liver resection were observed which are in line with previous reports [ 19 , 46 , 49 – 51 ]. Randomized studies comparing laparoscopic and robotic MIS liver resection are lacking and are warranted to explore the exact value of robotic MIS liver resection in the current MIS liver resection practice.…”

Section: Discussionsupporting

confidence: 91%

Impact of shifting from laparoscopic to robotic surgery during 600 minimally invasive pancreatic and liver resections

et al. 2022

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Background Many centers worldwide are shifting from laparoscopic to robotic minimally invasive hepato-pancreato-biliary resections (MIS-HPB) but large single center series assessing this process are lacking. We hypothesized that the introduction of robot-assisted surgery was safe and feasible in a high-volume center. Methods Single center, post-hoc assessment of prospectively collected data including all consecutive MIS-HPB resections (January 2010–February 2022). As of December 2018, all MIS pancreatoduodenectomy and liver resections were robot-assisted. All surgeons had participated in dedicated training programs for laparoscopic and robotic MIS-HPB. Primary outcomes were in-hospital/30-day mortality and Clavien-Dindo ≥ 3 complications. Results Among 1875 pancreatic and liver resections, 600 (32%) were MIS-HPB resections. The overall rate of conversion was 4.3%, Clavien-Dindo ≥ 3 complications 25.7%, and in-hospital/30-day mortality 1.8% (n = 11). When comparing the period before and after the introduction of robotic MIS-HPB (Dec 2018), the overall use of MIS-HPB increased from 25.3 to 43.8% (P < 0.001) and blood loss decreased from 250 ml [IQR 100–500] to 150 ml [IQR 50–300] (P < 0.001). The 291 MIS pancreatic resections included 163 MIS pancreatoduodenectomies (52 laparoscopic, 111 robotic) with 4.3% conversion rate. The implementation of robotic pancreatoduodenectomy was associated with reduced operation time (450 vs 361 min; P < 0.001), reduced blood loss (350 vs 200 ml; P < 0.001), and a decreased rate of delayed gastric emptying (28.8% vs 9.9%; P = 0.009). The 309 MIS liver resections included 198 laparoscopic and 111 robotic procedures with a 3.6% conversion rate. The implementation of robotic liver resection was associated with less overall complications (24.7% vs 10.8%; P = 0.003) and shorter hospital stay (4 vs 3 days; P < 0.001). Conclusion The introduction of robotic surgery was associated with greater implementation of MIS-HPB in up to nearly half of all pancreatic and liver resections. Although mortality and major morbidity were not affected, robotic surgery was associated with improvements in some selected outcomes. Ultimately, randomized studies and high-quality registries should determine its added value. Graphical Abstract

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Section: Discussionsupporting

confidence: 91%

Impact of shifting from laparoscopic to robotic surgery during 600 minimally invasive pancreatic and liver resections

et al. 2022

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“…In a study by Tee et al including only elderly patients, the grade B/C liver failure rates were significantly different following open and minimally invasive resections (4.84% versus 0.41%, respectively) [ 61 ]. In a nationwide study comparing open, laparoscopic, and robotic liver resections, the robotic group had the lowest liver failure rate (1.1%, 1.1%, and 0.7%, respectively) [ 66 ].…”

Section: Postoperative Outcomesmentioning

confidence: 99%

What Is the Current Role and What Are the Prospects of the Robotic Approach in Liver Surgery?

Bozkurt

Sijberden

Hilal

2022

Cancers

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In parallel with the historical development of minimally invasive surgery, the laparoscopic and robotic approaches are now frequently utilized to perform major abdominal surgical procedures. Nevertheless, the role of the robotic approach in liver surgery is still controversial, and a standardized, safe technique has not been defined yet. This review aims to summarize the currently available evidence and prospects of robotic liver surgery. Minimally invasive liver surgery has been extensively associated with benefits, in terms of less blood loss, and lower complication rates, including liver-specific complications such as clinically relevant bile leakage and post hepatectomy liver failure, when compared to open liver surgery. Furthermore, comparable R0 resection rates to open liver surgery have been reported, thus, demonstrating the safety and oncological efficiency of the minimally invasive approach. However, whether robotic liver surgery has merits over laparoscopic liver surgery is still a matter of debate. In the current literature, robotic liver surgery has mainly been associated with non-inferior outcomes compared to laparoscopy, although it is suggested that the robotic approach has a shorter learning curve, lower conversion rates, and less intraoperative blood loss. Robotic surgical systems offer a more realistic image with integrated 3D systems. In addition, the improved dexterity offered by robotic surgical systems can lead to improved intra and postoperative outcomes. In the future, integrated and improved haptic feedback mechanisms, artificial intelligence, and the introduction of more liver-specific dissectors will likely be implemented, further enhancing the robots’ abilities.

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“…A recent multicenter study (2016–2018) investigated the outcomes of RLS as compared with open and laparoscopic liver surgery in 28 states in the United States including 351 RLS procedures with a 3.1% use of RLS. 30 The authors reported an overall complication rate of 7.2%, a mean hospital stay of 2 days and a mortality of 0.9%. Although in the current study the overall morbidity was higher and hospital stay longer, the authors did not stratify postoperative outcomes for type of resection.…”

Section: Discussionmentioning

confidence: 93%

“…Nationwide retrospective studies on the implementation and outcomes of RLS are currently lacking and only a few retrospective multicenter studies have been performed. A recent multicenter study (2016–2018) investigated the outcomes of RLS as compared with open and laparoscopic liver surgery in 28 states in the United States including 351 RLS procedures with a 3.1% use of RLS 30. The authors reported an overall complication rate of 7.2%, a mean hospital stay of 2 days and a mortality of 0.9%.…”

Section: Discussionmentioning

confidence: 99%

Implementation and Outcome of Robotic Liver Surgery in the Netherlands

et al. 2022

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Objective: To determine the nationwide implementation and surgical outcome of minor and major robotic liver surgery (RLS) and assess the first phase of implementation of RLS during the learning curve. Background: RLS may be a valuable alternative to laparoscopic liver surgery. Nationwide population-based studies with data on implementation and outcome of RLS are lacking. Methods: Multicenter retrospective cohort study including consecutive patients who underwent RLS for all indications in 9 Dutch centers (August 2014–March 2021). Data on all liver resections were obtained from the mandatory nationwide Dutch Hepato Biliary Audit (DHBA) including data from all 27 centers for liver surgery in the Netherlands. Outcomes were stratified for minor, technically major, and anatomically major RLS. Learning curve effect was assessed using cumulative sum analysis for blood loss. Results: Of 9437 liver resections, 400 were RLS (4.2%) procedures including 207 minor (52.2%), 141 technically major (35.3%), and 52 anatomically major (13%). The nationwide use of RLS increased from 0.2% in 2014 to 11.9% in 2020. The proportion of RLS among all minimally invasive liver resections increased from 2% to 28%. Median blood loss was 150 mL (interquartile range 50–350 mL] and the conversion rate 6.3% (n=25). The rate of Clavien-Dindo grade ≥III complications was 7.0% (n=27), median length of hospital stay 4 days (interquartile range 2–5) and 30-day/in-hospital mortality 0.8% (n=3). The R0 resection rate was 83.2% (n=263). Cumulative sum analysis for blood loss found a learning curve of at least 33 major RLS procedures. Conclusions: The nationwide use of RLS in the Netherlands has increased rapidly with currently one-tenth of all liver resections and one-fourth of all minimally invasive liver resections being performed robotically. Although surgical outcomes of RLS in selected patient seem favorable, future prospective studies should determine its added value.

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Comprehensive analysis of laparoscopic, robotic, and open hepatectomy outcomes using the nationwide readmissions database

Cited by 15 publications

References 20 publications

Impact of shifting from laparoscopic to robotic surgery during 600 minimally invasive pancreatic and liver resections

Impact of shifting from laparoscopic to robotic surgery during 600 minimally invasive pancreatic and liver resections

What Is the Current Role and What Are the Prospects of the Robotic Approach in Liver Surgery?

Implementation and Outcome of Robotic Liver Surgery in the Netherlands

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