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 hemangiomas.Methods From April 2011 to April 2017, consecutive patients who underwent hemihepatectomy for giant liver haemangiomas were included into 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, tumor location, body surface area (BSA), future liver remnant volume (FLR), standard liver volume (SLV), liver hemangioma 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 significantly longer postoperative hospital stay (P< 0.05), time to oral intake (P < 0.05), 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 of the RH group was significantly shorter than 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 intraoperative blood loss of the RH group was the least among the three groups (P<0.05) and the intraoperative blood loss of the LH group was less than the OH group (P<0.05).Discussion Robotic, laparoscopic, and open hemihepatectomy were safe and efficacious treatments for giant liver hemangiomas. Robotic and laparoscopic hemihepatectomy were significantly better than open hemihepatectomy in intraoperative blood loss, postoperative recovery and pain score. Compared with laparoscopic hemihepatectomy, robotic hemihepatectomy was associated with significantly less intraoperative blood loss and shorter operative time.

Laparoscopic liver resection: indications, limitations, and economic aspects

“…In this respect, the question of feasibility depends primarily on whether the resection can be performed safely and within a reasonable time. Of note, if technically feasible, well-known advantages of minimally invasive surgery have also been confirmed in the literature for giant tumors [ 49 ]. Therefore, the decision whether to operate laparoscopically or rather conventionally open should be based on the findings and, again, on the own learning curve and personal experiences made.…”

Advances in minimally invasive surgery for hepatocellular carcinoma

“…Zhao et al [44] reported that successful robotic radical resection of hepatic echinococcosis located in posterosuperior liver segments, and robotic isolated partial and complete hepatic caudate lobectomy [45] . In addition, Hu et al [46] indicated that robotic and laparoscopic hemi-hepatectomies were associated with less intraoperative blood loss, better postoperative recovery and a lower pain score. Compared with laparoscopic hemi-hepatectomy, robotic hemi-hepatectomy was associated with significantly less intraoperative blood loss and a shorter operative time.…”