Robotic vs. laparoscopic major hepatectomy

Abstract

The introduction of laparoscopic technology and surgical robots in hepatobiliary surgery in the 1990s and 2000s, respectively, has dramatically revolutionized the field. Even though laparoscopic and robotic major hepatectomy was slower to adopt compared to minimally-invasive minor hepatectomy, the number of major hepatectomies performed with both approaches worldwide has significantly increased and is still rising. Despite the few comparative studies between laparoscopic and robotic major hepatectomy, most studies are focused on describing the procedures or reporting the outcomes of each method, either separately, or mixed with minor hepatectomies. Based on the available data, the direct comparison between the two techniques has shown that when robotic major hepatectomy is performed by experienced hepatobiliary surgeons in high-volume centers, it can lead to similar operating times, estimated blood loss, hospital length of stay, complication and mortality rates compared to its laparoscopic counterpart. The likelihood of achieving a margin-negative resection in cancer patients, as well as long-term disease-free and overall-survival are comparable between the groups. However, broader adoption of the robotic approach might be a hurdle in low-volume centers due to the high fixed capital and annual maintenance cost of the surgical robot.

Systematic review and meta-analysis of open versus laparoscopy-assisted versus pure laparoscopic versus robotic living donor hepatectomy

“…The gradual and widespread adoption of minimally invasive (MI) liver surgery throughout the world has generated data showing equivalent or even superior outcomes after MI minor and major hepatectomy versus open hepatectomy. [4][5][6][7][8] Therefore, the growing surgical experience allowed several groups to perform laparoscopy-assisted, pure laparoscopic, and robotic living donor hepatectomy in comparison to the conventional open approach (LALDH, PLLDH, RLDH, OLDH). [9][10][11][12] In fact, several international consensus conferences have deemed PLLDH a standard practice for LLS and eligible for LH and well-selected RH cases, while RLDH was still deemed to be in its early phase compared with PLLDH, yet can be an acceptable alternative in experienced high-volume centers.…”

“…The gradual and widespread adoption of minimally invasive (MI) liver surgery throughout the world has generated data showing equivalent or even superior outcomes after MI minor and major hepatectomy versus open hepatectomy 4–8 . Therefore, the growing surgical experience allowed several groups to perform laparoscopy-assisted, pure laparoscopic, and robotic living donor hepatectomy in comparison to the conventional open approach (LALDH, PLLDH, RLDH, OLDH) 9–12 .…”

Initial experience with a robotic hepatectomy program at a high-volume laparoscopic center: single-center experience and surgical tips

“…Since then, liver surgeons have attempted to expand the application of robotic systems in hepatic resection. Several studies have reported that robotic hepatectomy (RH) is both safe and feasible (9)(10)(11)(12)(13)(14). Although operation times are longer for RH than for LH, a recent meta-analysis demonstrated that the postoperative complications and oncologic outcomes of RH are comparable to those of LH (15).…”