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

Abstract

Background: Robotic platform has been increasingly applied in major hepatectomy. However, the role or advantage of robotic approach comparing with laparoscopic approach in major hepatectomy remains controversial. This meta-analysis compares perioperative outcomes of robotic major hepatectomy (RMH) to laparoscopic major hepatectomy (LMH) for hepatic neoplasms. Methods: PubMed, Web of Science, EMBASE, and Cochrane Library were searched to identify comparative studies compared RMH versus LMH for hepatic neoplasms. The search timeframe was set before May 2023. Main outcomes were mortality, overall morbidities, serious complications, and conversion to open surgery. Secondary outcomes were operative time, intraoperative blood loss, blood transfusion, postoperative length of hospital stay, R0 resection, reoperation, and readmission. Studies were evaluated for quality by Cochrane risk of bias tool or Newcastle-Ottawa scale. Data were pooled as odds ratio (OR) or mean difference (MD). This study was registered at PROSPERO (CRD#). Results: Twelve retrospective cohort studies concerning total 1657 patients (796 RMH, 861 LMH) were included. Meta-analyses showed no significant differences in mortality (OR=1.23, 95% CI=0.50–2.98, P=0.65), overall postoperative complications (OR=0.83, 95% CI=0.65–1.06, P=0.14), operative time (MD=6.47, 95% CI=−14.72 to 27.65, P=0.55), blood transfusion (OR=0.77, 95% CI=0.55–1.08, P=0.13), R0 resection (OR=1.45, 95% CI=0.91–2.31, P=0.12), reoperation (OR=0.76, 95% CI=0.31–1.88, P=0.56), and readmission (OR=0.63, 95% CI=0.28–1.44, P=0.27) between RMH and LMH. Incidence of serious complications (OR=0.60, 95% CI=0.40–0.90, P=0.01), conversion to open surgery (OR=0.41, 95% CI=0.27–0.63, P<0.0001), blood loss (MD=−91.42, 95% CI=−142.18 to −40.66, P=0.0004), and postoperative hospital stay (MD=−0.64, 95% CI=−0.78 to −0.49, P<0.00001) were reduced for RMH versus LMH. Conclusions: RMH is associated with comparable short-term surgical outcomes and oncologic adequacy compared to LMH when performed by experienced surgeons at large centers. RMH may result in reduced major morbidities, conversion rate, blood loss, and hospital stay, but these results were volatile. Further randomized studies should address the potential advantages of RMH over LMH.

Robotic-assisted cholecystectomy: stepping stone to expertise or vogue?

“…For simple procedures such as cholecystectomy, robotic surgery is generally considered non inferior to laparoscopy ( 5 ). Conversely, emerging evidence indicates potential advantages of robotic surgery over laparoscopy in complex oncological hepato-pancreatico-biliary (HPB) procedures regarding several outcomes ( 6 , 7 ). Nevertheless, the learning curve of robotic surgery expertise for complex procedures, such as distal pancreatectomy, is long with an estimated 85 cases required to reach primary textbook outcomes ( 8 ).…”

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

“…We recently reviewed the meta-analysis by Mao et al . 5 , which examined the safety and short-term efficacy of robotic versus laparoscopic hepatectomy. The authors assessed 12 studies involving 1657 patients, concluding that robotic major hepatectomy (RMH) and laparoscopic major hepatectomy (LMH) had analogous short-term surgical outcomes and tumor sufficiency.…”