Robotic versus conventional laparoscopic liver resections: A systematic review and meta-analysis

Abstract

Background: Theoretical advantages of robotic surgery compared to conventional laparoscopic surgery include improved instrument dexterity, 3D visualization, and better ergonomics. This systematic review and meta-analysis aimed to determine advantages of robotic surgery over laparoscopic surgery in patients undergoing liver resections. Method: A systematic literature search was conducted for studies comparing robotic assisted or totally laparoscopic liver resection. Meta-analysis of intraoperative (operative time, blood loss, transfusion rate, conversion rate), oncological (R0 resection rates), and postoperative (bile leak, surgical site infection, pulmonary complications, 30-day and 90-day mortality, length of stay, 90-day readmission and reoperation rates) outcomes was performed using a random effects model. Result: Twenty-six non-randomized studies including 2630 patients (950 robotic and 1680 laparoscopic) were included, of which 20% had major robotic liver resection and 14% had major laparoscopic liver resection. Intraoperatively, robotic liver resection was associated with significantly less blood loss (mean: 286 vs 301 mL, p < 0.001) but longer operating time (mean: 281 vs 221 min, p < 0.001). There were no significant differences in conversion rates or transfusion rates between robotic liver resection and laparoscopic liver resection. Postoperatively, there were no significant differences in overall complications, bile leaks, and length of hospital stay between robotic liver resection and laparoscopic liver resection. However, robotic liver resection was associated with significantly lower readmission rates than laparoscopic liver resection (odds ratio: 0.43, p = 0.005). Conclusion: Robotic liver resection appears to offer some advantages compared to conventional laparoscopic surgery, although both techniques appear equivalent. Importantly, the quality of evidence is generally limited to cohort studies and a high-quality randomized trial comparing both techniques is needed.

Robotic Liver Surgery – Current Standards and Future Perspectives

“…Compared to open (n = 10 146) and laparoscopic (n = 520) hepatectomy, robotic procedures (n = 204) were associated with a shorter length of stay and less frequent non-elective readmission within 45 days. Same results were reported in two recent meta-analyses by Kamarajah et al as well as by Gavriilidis et al revealing significantly lower readmission rate for robotic compared with laparoscopic liver resections [13,31]. All of this provide evidence of favorable recovery in patients undergoing robotic liver resection as evident by reduced complications, lower rates of intensive care unit admissions, shorter length of stay and less frequent non-elective readmissions.…”

“…Guan et al analyzed pooled data from 435 robotic and 503 laparoscopic cases and found a significantly increased blood loss in the robotic cohort [37]. This is in contrast to recent meta-analyses by Kamarajah et al, including 2630 patients (950 robotic and 1680 laparoscopic cases) undergoing liver resection, revealing a significantly reduced estimated blood loss with no differences in transfusion rates between robotic and laparoscopic liver resection [31]. Among the possible explanations for the apparently conflicting finding regarding intraoperative blood loss is the mixed population of major and minor resections, with a trend to more extensive resections in the robotic cohorts.…”

Outcomes of robotic‐assisted liver surgery versus laparoscopic liver surgery for treatment of stage I hepatocellular carcinoma

“…However, no significant differences were found in conversion rates, transfusion rates, complications, bile leaks, or length of hospital stay between these surgeries. 19 Moreover, robotic surgery had a significantly lower readmission rate compared with laparoscopic surgery (odds ratio = 0.43; P < .01). 19 These findings reaffirm our findings that robotic surgery has an equivalent short-term outcome compared with laparoscopic surgery in treating early-stage HCC.…”

Advances in minimally invasive surgery for hepatocellular carcinoma

“…However, there is one thing worthy of our attention that patients undergoing robotic liver resection have a higher readmission rates (P = 0.005), Compared with traditional open surgery, minimally invasive surgery (robot and laparoscopic) is more expensive, but there is no statistical difference. It can significantly reduce intraoperative blood loss and shorten the length of stay; the tumor volume of patients undergoing laparoscopic liver resection was significantly reduced than patients in the open surgery group [47][48][49] . Minimally invasive surgery for HCC is not a simple minimally invasive technology, but a process of minimally invasive concept and comprehensive treatment.…”