Robot assistance in liver surgery: a real advantage over a fully laparoscopic approach? Results of a comparative bi‐institutional analysis

Abstract

The major hepatectomy rate was significantly higher in LAPR (16.6% vs 0%, p = 0.011) while a parenchyma-preserving approach was favoured in ROBR (55% vs 34.1%, p = 0.019). More nodules were resected in the ROBR group (1.97 ± 1.4 vs 1.57 ± 1.1, p = 0.04). Overall conversion rate was 8/40 (20%) in the ROBR and 17/223 (7.6%) in the LAPR group (p = 0.034). Mean blood loss was 330 ± 303 ml and 174 ± 133 ml for the ROBR and LAPR groups, respectively (p = 0.001) CONCLUSIONS: Despite higher conversion rates and blood loss, robot-assisted surgery may allow the resection of more liver lesions, especially those located in the postero-superior segments, facilitating parenchyma-saving surgery with a comparable complication rate with respect to LAPR.

Recent advances in surgical treatment of hepatocellular carcinoma

“…A point worth noting is that the robotic approach has not been followed for a long enough period of time, so that approach needs to be examined in comparison to other approaches. Nevertheless, the robotic approach provides results, at 2 years for treatment of HCC (88) and at 3 years for treatment of colorectal metastasis (97), that are similar to those reported in systematic reviews of laparoscopic approaches (96). The increasing interest in robotic technology should help encourage randomized studies with larger samples and a longer follow-up.…”

An organizational model to improve the robotic system among general surgeons

“…Robotic approach was developed in an effort to overcome these limitations and major pancreatectomies and liver resections reports are increasing in the current literature (16)(17)(18). We believe that the potentiality of robotic is higher especially in HBP field (19). In 2012, in our department, almost 80 pancreatic and 50 liver resections have been performed.…”

Application of da Vinci surgical robotic system in hepatobiliary surgery

“…For a malignant tumour, it has severe extrusion and traction to the liver which may cause the tumour cell entering blood vessels, postoperative relapse or distant metastasis in short time. In consequence, laparoscopic hepatectomy is a dream of liver surgeon [3]. However, laparoscopic hepatectomy is a surgery with great difficulty and high risk.…”

“…The application of Da Vinci on hepatectomy is safe and feasible with advantages such as low open abdominal rate, few hemorrhage during operation, small trauma, rapid recovery and short HLOS et. which have increased the hepatectomy scope (such as focus on rear-upper section of liver), and reflected the concept of precise liver resection better [3]. Also, hepatectomy under the robot-assisted under the Da Vinci surgical system increasingly become mature which has laid a foundation for liver transplantation under the assistance of the …”