Systematic review and meta‐analysis of robotic versus open hepatectomy

Wong, Daniel J.; Wong, Man-Shun; Choi, Gi Hong; Wu, Yao‐Ming; Lai, Paul; Goh, Brian K. P.

doi:10.1111/ans.14690

Cited by 54 publications

(42 citation statements)

References 36 publications

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“…Although general MIS, including robotic surgery, has frequently been associated with shorter hospital stays and even a decrease in morbidity (5,6) compared to the open approach, these may not be sufficient to defray the increase in intraoperative costs. (51) Moreover, it is important to note that the benefits of MIS tend to decrease and be less obvious as the complexity of the surgical procedure increases. However, most comparative studies only analyse short-term perioperative outcomes and do not include analyses of other important longer-term outcomes such as time to return to normal activity/work, long-term wound pain or discomfort, wound paraesthesia, incisional hernias, cosmesis and other quality of life measures that would be negatively affected by a long open laparotomy incision.…”

Section: Discussionmentioning

confidence: 99%

First experience with robotic pancreatoduodenectomy in Singapore

Low

Koh

Goh

2020

smedj

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Section: Discussionmentioning

confidence: 99%

First experience with robotic pancreatoduodenectomy in Singapore

Low

Koh

Goh

2020

smedj

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“…Wong et al[23] reported a meta-analysis of 7 retrospective, case-control studies on robotic and open hepatectomy conducted between 2013 and 2016. The analysis evaluated the intraoperative and short-term postoperative outcome in 329 cases of robotic hepatectomy and 426 cases of open hepatectomy in Italy, the United States, Switzerland, and China.…”

Section: Methodsmentioning

confidence: 99%

“…However, conclusions on operative time, intraoperative blood loss, conversion rate, incidence of postoperative complications, and overall cost-benefit ratio remain divided in different reports, with the main controversy surrounding the application of certain procedure modalities. These factors severely limit the application of robotic hepatectomy[6,21,23,24,31,32,36,37,39,42,57]. Some researchers have pointed out that it is undesirable to simply increase economic expenses and aggressively apply robot-assisted laparoscopic surgical system for procedures such as living-donor hepatectomy while therapeutic efficacy is not improved[58-61].…”

Section: Introductionmentioning

confidence: 99%

International consensus statement on robotic hepatectomy surgery in 2018

Liu¹,

Wakabayashi²,

Kim³

et al. 2019

WJG

170

129

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The robotic surgical system has been applied in liver surgery. However, controversies concerns exist regarding a variety of factors including the safety, feasibility, efficacy, and cost-effectiveness of robotic surgery. To promote the development of robotic hepatectomy, this study aimed to evaluate the current status of robotic hepatectomy and provide sixty experts’ consensus and recommendations to promote its development. Based on the World Health Organization Handbook for Guideline Development, a Consensus Steering Group and a Consensus Development Group were established to determine the topics, prepare evidence-based documents, and generate recommendations. The GRADE Grid method and Delphi vote were used to formulate the recommendations. A total of 22 topics were prepared analyzed and widely discussed during the 4 meetings. Based on the published articles and expert panel opinion, 7 recommendations were generated by the GRADE method using an evidence-based method, which focused on the safety, feasibility, indication, techniques and cost-effectiveness of hepatectomy. Given that the current evidences were low to very low as evaluated by the GRADE method, further randomized-controlled trials are needed in the future to validate these recommendations.

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“…It allowed surgeons to easily perform more precise and delicate dissection and suturing in extremely tight spaces compared to conventional laparoscopy, useful for HPB procedures such as fine dissection in the hilar region and the performance of difficult anastomoses such as pancreatojejunostomies 22 and hepaticojejunostomies. 23 Increasing number of studies have also been published demonstrating the advantages of robotic assistance for hepatectomies 24 and pancreatectomies. 25 Other reported advantages of robotic HPB surgery over conventional laparoscopy include the shorter learning curve 26 and lower open conversion rate 27 but at the expense of longer operation time and increased cost.…”

Section: Introductionmentioning

confidence: 99%

Adoption of Robotic Liver, Pancreatic and Biliary Surgery in Singapore: A Single Institution Experience with Its First 100 Consecutive Cases

Goh

Low

Teo

et al. 2020

Ann Acad Med Singap

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Introduction: Presently, robotic hepatopancreatobiliary surgery (RHPBS) is increasingly adopted worldwide. This study reports our experience with the first 100 consecutive cases of RHPBS in Singapore. Methods: Retrospective review of a single-institution prospective database of the first 100 consecutive RHPBS performed over 6 years from February 2013 to February 2019. Eighty-six cases were performed by a single surgeon. Results: The 100 consecutive cases included 24 isolated liver resections, 48 pancreatic surgeries (including 2 bile duct resections) and 28 biliary surgeries (including 8 with concomitant liver resections). They included 10 major hepatectomies, 15 pancreaticoduodenectomies, 6 radical resections for gallbladder carcinoma and 8 hepaticojejunostomies. The median operation time was 383 minutes, with interquartile range (IQR) of 258 minutes and there were 2 open conversions. The median blood loss was 200ml (IQR 350ml) and 15 patients required intra-operative blood transfusion. There were no post-operative 90-day nor in-hospital mortalities but 5 patients experienced major (> grade 3a) morbidities. The median post-operative stay was 6 days (IQR 5 days) and there were 12 post-operative 30-day readmissions. Comparison between the first 50 and the subsequent 50 patients demonstrated a significant reduction in blood loss, significantly lower proportion of malignant indications, and a decreasing frequency in liver resections performed. Conclusion: Our experience with the first 100 consecutive cases of RHPBS confirms its feasibility and safety when performed by experienced laparoscopic hepatopancreatobiliary surgeons. It can be performed for even highly complicated major hepatopancreatobiliary surgery with a low open conversion rate. Keywords: Biliary surgery, hepaticojejunostomy, liver resection, pancreas, pancreaticoduodenectomy

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Systematic review and meta‐analysis of robotic versus open hepatectomy

Abstract: RH had superior perioperative outcomes and was not cost prohibitive compared to OH, but had longer operation times.

Cited by 54 publications

References 36 publications

First experience with robotic pancreatoduodenectomy in Singapore

First experience with robotic pancreatoduodenectomy in Singapore

International consensus statement on robotic hepatectomy surgery in 2018

Adoption of Robotic Liver, Pancreatic and Biliary Surgery in Singapore: A Single Institution Experience with Its First 100 Consecutive Cases

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