Initial experience with robotic liver resection: Audit of 120 consecutive cases at a single center and comparison with open and laparoscopic approaches

Abstract

Background/Purpose: Surgical outcomes and utility of robotic liver resection (RLR) are undefined. Methods: We retrospectively studied perioperative and long-term outcomes of the single-center 120 RLRs including non-anatomic (NAR, n = 58) and anatomic (AR, n = 62) resections. To evaluate the feasibility and safety of RLR, perioperative outcomes of RLR (n = 103) were compared to those of open (OLR, n = 495) or laparoscopic (LLR, n = 451) resection in liver-only resections without reconstruction, using 1:1 propensity score matching (PSM). The changing trends from the earlier to the later RLR cases were assessed. Long-term outcomes were compared between RLR and LLR.Results: Various types of RLR with different surgical difficulties were performed, with mostly comparable postoperative morbidity between AR and NAR, or among AR subtypes. In segmentectomy and sectionectomy cases, perioperative outcomes significantly improved in the later period. In comparison between PSM-selected OLR and RLR cases (87:87), RLR had significantly longer operative time, less blood loss, and shorter hospital stay. PSM-selected LLR and RLR cases (91:91) showed comparable perioperative outcomes. Overall and recurrence-free survivals after RLR for newly diagnosed hepatocellular carcinoma and colorectal metastasis were comparable to those after LLR.Conclusions: RLR is applicable to various types of liver resection with acceptable perioperative and long-term outcomes in select patients.

Minimally Invasive Anatomic Liver Resection for Hepatocellular Carcinoma Using the Extrahepatic Glissonian Approach: Surgical Techniques and Comparison of Outcomes with the Open Approach and between the Laparoscopic and Robotic Approaches

“…As for technical aspects of MIAR, we believe, from the current and previous results, that we can standardize MIAR by using the extrahepatic Glissonian approach and HV root-at first one-way parenchymal dissection [ 4 , 5 , 6 , 13 , 18 , 19 , 23 ]. Furthermore, the consistent usage of these standardized techniques, irrespective of OAR and MIAR, may reduce technical biases, being an advantage of this study setting.…”

“…Previous studies comparing open and minimally invasive liver resections have shown less blood loss, decreased morbidity, and shorter LOS in the latter [ 23 , 26 , 27 , 28 , 29 ]. Laparoscopic and robotic liver resections were shown to have comparable perioperative outcomes [ 23 , 30 ].…”

“…Previous studies comparing open and minimally invasive liver resections have shown less blood loss, decreased morbidity, and shorter LOS in the latter [ 23 , 26 , 27 , 28 , 29 ]. Laparoscopic and robotic liver resections were shown to have comparable perioperative outcomes [ 23 , 30 ]. Results of the current study are in line with those of these studies, though the cohort setting was different; very few studies exclusively selected AR cases for the cohort.…”

Current status of minimally invasive liver surgery for cancers

“…)-guided small anatomical resection[ 38 ], indocyanine green (ICG)-guided anatomical resection and tumor identification[ 39 ], and LLR with a Glissonian approach to more peripheral smaller branches from the hilum (cone unit resection)[ 40 ]. Robot-assisted LLR is an important emerging tool under discussion[ 25 , 41 ]. It could be advantageous, for example, in cases exposing a wide range of Glissonian pedicles and major hepatic veins.…”

Minimally invasive isolated anatomic liver segmentectomy for hepatocellular carcinoma using extrahepatic Glissonian approach: surgical techniques and outcomes

“…This method devised by Makuuchi is widely used in open surgery [1] , but it poses significant difficulties or needs special expertise in MIS because of technical or instrumental insufficiency [11] . The other is the conventional "negative-coloring method" without the use of dye or the "negative-staining method" which visualizes the target segment as a negatively stained area through systemic injection of indocyanine green (ICG), after occluding the target segmental GPs that are isolated intrahepatically or extrahepatically [8][9][10][12][13][14][15] . Recent technical refinements in isolation of segmental GPs, as well as advances in fluorescence navigation technology, have promoted the application of the negative-staining method in open and minimally invasive IA-Seg.…”