Robotic, laparoscopic or open hemihepatectomy for giant liver haemangiomas over 10 cm in diameter

Abstract

Background: To evaluate the clinical efficacy of robotic, laparoscopic, and open hemihepatectomy for giant liver haemangiomas.Methods: From April 2011 to April 2017, consecutive patients who underwent hemihepatectomy for giant liver haemangiomas were included in this study. According to the type of operation, these patients were divided into the robotic hemihepatectomy (RH) group, the laparoscopic hemihepatectomy (LH) group, and the open hemihepatectomy (OH) group. The perioperative and short-term postoperative outcomes were compared among the three groups. The study was reported following the STROCSS criteria.Results: There were no significant differences in age, sex, tumour location, body surface area (BSA), future liver remnant volume (FLR), standard liver volume (SLV), liver haemangioma volume, FLR/SLV, resected normal liver volume/resected volume, hepatic disease, rates of blood transfusion, liver function after 24 hours of surgery, operative morbidity and mortality among the three groups. Compared with patients in the RH group (n=19) and the LH group (n=13), patients in the OH group (n=25) had a significantly longer postoperative hospital stay (P< 0.05), time to oral intake (P < 0.05), and time to get-out-of-bed (P < 0.05); a higher VAS score after 24 hours of surgery (P < 0.05); and a shorter operative time (P < 0.05). There were no significant differences in these postoperative outcomes (P＞0.05) between the RH group and the LH group. When the setup time in the RH group was excluded, the operative time in the RH group was significantly shorter than that in the LH group (P＜0.05). There was no significant difference in the operative time between the RH group and the OH group (P＞0.05). The amount of intraoperative blood loss in the RH group was the lowest among the three groups (P＜0.05), and the amount of intraoperative blood loss in the LH group was less than that in the OH group (P＜0.05).Conclusion: Robotic and laparoscopic hemihepatectomies were associated with less intraoperative blood loss,better postoperative recovery and lower pain score. Compared with laparoscopic hemihepatectomy, robotic hemihepatectomy was associated with significantly less intraoperative blood loss and a shorter operative time.

Robot‐assisted versus conventional laparoscopic major hepatectomies: Systematic review with meta‐analysis

“…Weighted mean age was 55.9 versus 54.1 years, while weighted mean BMI was 25.4 versus 27.5 for the robotic and laparoscopic group, respectively. The two groups did not differ significantly in terms of age ( p = 0.28; I 2 = 30; SMD 0.14, data from seven studies and 461 patients) 20–25,27 and BMI ( p = 0.27; I 2 = 78; SMD −0.29, data from six studies and 420 patients) 20,22–25,27 …”

“…The characteristics of the included studies are given in Table 1. The indications for surgery included both malignant and benign liver disease in all studies except for one on hepatectomy for giant haemangioma 21 . The percentage of oncological patients was 67.5% and 55.5% in the robotic and laparoscopic group, respectively (429 patients from six studies; p = 0.01; I 2 = 67%) 20,22–25,27 .…”

“…The titles and abstracts were examined, duplicates were excluded and full texts of potentially eligible paper were appraised. Finally, eight studies including 485 patients met all inclusion criteria and were meta‐analysed 20–27 . All studies were retrospective analyses of single‐ or multicenter series, and no randomised controlled trial has been retrieved.…”

“…There were 244 and 241 patients who received RMH and LMH, respectively. Data on the proportion of formal hemihepatectomy were available from six studies including 440 patients 20–23,25,27 . Right hemihepatectomy accounted for the 45.8% versus 44.8% of resection in the RMH and LMH group, respectively ( p = 0.49; I 2 = 0), while the proportion of left hemihepatectomy was 36.3% versus 28.1% ( p = 0.90; I 2 = 60).…”

“…Detailed data on OT were available for 461 patients from seven papers 20–25,27 . Robotic and laparoscopic procedures required an average time ranging between 194 and 456 and between 204 and 565 min to be completed, respectively.…”