Robotic versus laparoscopic major hepatectomy for hepatocellular carcinoma: short-term outcomes from a single institution

Abstract

Background Currently, an increasing number of robotic major hepatectomies for hepatocellular carcinoma (HCC) are being performed. Despite the advantages of robotic surgery over laparoscopic procedures, studies comparing robotic with laparoscopic major hepatectomy in terms of short-term results remain scarce. This study was performed to compare robotic major hepatectomy and laparoscopic major hepatectomy in terms of their intraoperative and postoperative results. Methods Data regarding demographics and intraoperative and postoperative results of 131 patients undergoing robotic or laparoscopic major hepatectomy between January 2017 and March 2022 were retrieved from their medical records and compared between the two types of surgery. Results Between January 2017 and March 2022, 44 robotic major hepatectomies and 87 laparoscopic major hepatectomies were performed at the Department of Hepatobiliary and Pancreatic Surgery, Shenzhen People’s Hospital. Patients undergoing robotic major hepatectomy were not significantly different from those undergoing laparoscopic major hepatectomy in terms of age (P = 0.397), sex (P = 0.624), body mass index (BMI) (P = 0.118), alpha-fetoprotein (AFP) (P = 0.09), tumor size (P = 0.176), cirrhosis (P = 0.384), fatty liver (P = 0.162), preoperative antiviral treatment (P = 0.934), hepatitis B virus (HBV) DNA (P = 0.646) and operation type (P = 0.054). Robotic major hepatectomy was associated with a longer operation time (median: 255.5 versus 206.8 min; P < 0.001) and less estimated blood loss (median: 118.9 versus 197.0 ml; P = 0.002) than laparoscopic major hepatectomy. However, robotic major hepatectomy was not significantly different from laparoscopic major hepatectomy regarding length of postoperative hospital stay (P = 0.849), open conversion (P = 0.077), ICU stay (P = 0.866), postoperative massive abdominal bleeding (P = 1.00), portal vein thrombosis (P = 1.00), abdominal infection (P = 1.00), pulmonary infection (P = 1.00), pulmonary embolism (P = 1.00), cardiac complications (P = 1.00), liver failure (P = 1.00), kidney failure (P = 1.00), biliary leak (P = 1.00), positive resection margin (P = 1.00), 30-day mortality (P = 1.00) and 90-day mortality (P = 1.00). Conclusions Robotic major hepatectomy was as effective as laparoscopic surgery in terms of intraoperative and postoperative results but took longer and could more efficiently control intraoperative blood loss.

Comparison of safety and effectiveness between robotic and laparoscopic major hepatectomy: A systematic review and meta-analysis

“…Major hepatectomy is a more technically demanding and time-consuming procedure, which can attribute to the difficulty in mobilization and exposure of a heavier portion of the liver, and the challenging dissection and transection of liver parenchyma. There was a tendency for patients to experience longer operative time during robotic liver resection because the additional time to dock the robot reported in previous study 37 . However, recent international studies from high volume centres have reported comparable operative time between robotic and laparoscopic surgeries 33 , 34 , 41 .…”

“… 36 on hepatectomy for giant haemangioma and the study by Liu et al . 37 on hepatectomy for hepatocellular carcinoma. Four studies 32 , 35 , 39 , 42 were not adequately matched in reviewed baseline characteristics such as age, BMI, and malignancy rate.…”

“…The study by Liu et al . 37 reported a history of upper abdominal surgery might contraindicate for minimally invasive major hepatectomy. The rates of previous abdominal surgery history reported in each treatment group were between 10.4 and 65.0%.…”

Robotic Major Hepatectomy in Elderly Patient

“…The robotic platform, thanks to endowrist technology, freedom of movement, and three-dimensional optics, can avoid injuries to major vessels. It allows for accurate identification and dissection of vessels for inflow and outflow control during liver resection [ 24 ]. In our series, the operative time was 332 min in the total population and 358 min in the elderly population, higher than that reported in other studies analyzing major hepatectomies in elderly patients.…”

Avaliação Da Eficácia E Segurança Da Hepatectomia Laparoscópica Versus Aberta Em Pacientes Com Carcinoma Hepatocelular

“…2 Acadêmico de Medicina, Faculdades Integradas Pitagoras -Afya Unifipmoc. 3 Médico, Universidade Federal de Mato Grosso do Sul UFMS. 4 Academico de Medicina Faculdade Ciências Médicas de Minas Gerais FCMMG.…”