Robotic major liver resections: Surgical outcomes compared with open major liver resections

Abstract

Backgrounds/Aims: Laparoscopic major liver resections are still considered innovative procedures despite the recent development of laparoscopic liver surgery. Robotic surgery has been introduced as an innovative system for laparoscopic surgery. In this study, we investigated surgical outcomes after major liver resections using robotic systems. Methods: From January 2009 to October 2018, 70 patients underwent robotic major liver resections, which included conventional major liver resections and right sectionectomy. The short-term and long-term outcomes were compared with 252 open major resections performed during the same period. Results: Operative time was longer in the robotic group (472 min vs. 349 min, p＜0.001). However, estimated blood loss was lower in the robotic group compared with the open resection group (269 ml vs. 548 ml, p=0.009). The overall postoperative complication rate of the robotic group was lower than that of the open resection group (31.4% vs. 58.3%, p＜0.001), but the major complication rate was similar between the two groups. Hospital stay was shorter in the robotic group (9.5 days vs. 15.1 days, p=0.006). Among patients with HCC, cholangiocarcinoma, and colorectal liver metastasis, there was no difference in overall and disease-free survival between the two groups. After propensity score matching in 37 patients with HCC for each group, the robotic group still showed a shorter hospital stay and comparable long-term outcomes. Conclusions: Robotic major liver resections provided improved perioperative outcomes and comparable long-term oncologic outcome compared with open resections. Therefore, robotic surgery should be considered one of the options for minimally invasive major liver resections.

Robotic Surgery for Biliary Tract Cancer

“…All reviewers approved of the final set of included studies. In total, 11 studies reported data on 146 patients undergoing robotic surgery for cholangiocarcinoma (CC) [ 5 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ], and 10 studies reported data on 113 patients undergoing robotic surgery for gallbladder cancer (GBC) [ 6 , 15 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ].…”

“…Yang et al compared 70 robotic liver resections (only 6 of which included CC) to 252 open liver resections. They reported longer operative time with the robotic approach, but shorter length of stay and lower blood loss [ 12 ]. Xu et al is the only study comparing the robotic ( n = 10) and open ( n = 32) approach strictly in patients with CC.…”

Laparoscopic versus open hepatectomy for hepatocellular carcinoma with cirrhosis: a single-center propensity score matching analysis

“…In addition, laparoscopic robotic surgery, with its greater flexibility, can overcome the limitations of laparoscopic surgery alone and improve surgical accuracy. Furthermore, compared with open surgery, robotic surgery can shorten the length of hospital stay and reduce postoperative complications (23). However, prospective and randomized controlled studies comparing LH and OH have not been carried out.…”

Laparoscopic and Robot-Assisted Hepatic Surgery: An Historical Review

“…A comparison of short- and long-term outcomes of 70 patients who underwent robot-assisted hepatic resections with a group of 252 patients who underwent open hepatic resections was reported [ 72 ]. Operative time was longer in the robot-assisted group (472 min vs. 349 min, p < 0.001), and estimated blood loss was lower in the robot-assisted group (269 mL vs. 548 mL, p = 0.009).…”