Robotic vs. laparoscopic liver surgery: a single-center analysis of 600 consecutive patients in 6 years

Abstract

Background While laparoscopic liver surgery has become a standard procedure, experience with robotic liver surgery is still limited. The aim of this prospective study was to evaluate safety and feasibility of robotic liver surgery and compare outcomes with conventional laparoscopy. Methods We here report the results of a single-center, prospective, post-marketing observational study (DRKS00017229) investigating the safety and feasibility of robotic liver surgery. Baseline characteristics, surgical complexity (using the IWATE score), and postoperative outcomes were then compared to laparoscopic liver resections performed at our center between January 2015 and December 2020. A propensity score-based matching (PSM) was applied to control for selection bias. Results One hundred twenty nine robotic liver resections were performed using the da Vinci Xi surgical system (Intuitive) in this prospective study and were compared to 471 consecutive laparoscopic liver resections. After PSM, both groups comprised 129 cases with similar baseline characteristics and surgical complexity. There were no significant differences in intraoperative variables, such as need for red blood cell transfusion, duration of surgery, or conversion to open surgery. Postoperative complications were comparable after robotic and laparoscopic surgery (Clavien–Dindo ≥ 3a: 23% vs. 19%, p = 0.625); however, there were more bile leakages grade B–C in the robotic group (17% vs. 7%, p = 0.006). Length of stay and oncological short-term outcomes were comparable. Conclusions We propose robotic liver resection as a safe and feasible alternative to established laparoscopic techniques. The object of future studies must be to define interventions where robotic techniques are superior to conventional laparoscopy.

Concomitant training in robotic and laparoscopic liver resections of low-to-intermediate difficulty score: a retrospective analysis of the learning curve

“…Major hepatobiliary centers usually started robotic programs after a solid background of laparoscopic liver surgery, and the point of the safety of simultaneous training could not be addressed. For example, D’Hondt and his team from Belgium performed LLRs-only for 8 years before the transition to RLR; similarly, the Berlin experience consisted of at least 7 years of LLRs before starting with RLRs 11 , 28 . The features of a purely robotic learning curve would be interesting but could not be addressed in the present study; however, it could be investigated following the same scheme.…”

Concomitant training in robotic and laparoscopic liver resections of low-to-intermediate difficulty score: a retrospective analysis of the learning curve

“…similarly, the Berlin experience consisted of at least 7 years of LLRs before starting with RLRs. (11,27) The features of a purely robotic LC would be interesting, but could not be addressed in the present study; however, it could be investigated following the same scheme.…”

Positioning of Minimally Invasive Liver Surgery for Hepatocellular Carcinoma: From Laparoscopic to Robot-Assisted Liver Resection

“…Zhu et al [148] revealed intra-and postoperative outcomes among patients who underwent RALR (n = 71), LLR (n = 141), and OLR (n = 157) for HCC; operation time was shortest and the length of hospital stay was longest in patients who underwent OLR, and similar results were demonstrated between those who did RALR and LLR. Conversely, some studies reported a higher incidence of postoperative bile leakage after RALR [149][150][151]. RALR is easy to manipulate in the hepatic hilum, but the lack of tactile sensation may cause inadvertent bile duct injury.…”