Laparoscopic versus Robotic Hepatectomy: A Systematic Review and Meta-Analysis

Abstract

This study aimed to assess the surgical outcomes of robotic compared to laparoscopic hepatectomy, with a special focus on the meta-analysis method. Original studies were collected from three Chinese databases, PubMed, EMBASE, and Cochrane Library databases. Our systematic review was conducted on 682 patients with robotic liver resection, and 1101 patients were operated by laparoscopic platform. Robotic surgery has a long surgical duration (MD = 43.99, 95% CI: 23.45–64.53, p = 0.0001), while there is no significant difference in length of hospital stay (MD = 0.10, 95% CI: −0.38–0.58, p = 0.69), blood loss (MD = −20, 95% CI: −64.90–23.34, p = 0.36), the incidence of conversion (OR = 0.84, 95% CI: 0.41–1.69, p = 0.62), and tumor size (MD = 0.30, 95% CI: −0–0.60, p = 0.05); the subgroup analysis of major and minor hepatectomy on operation time is (MD = −7.08, 95% CI: −15.22–0.07, p = 0.09) and (MD = 39.87, 95% CI: −1.70–81.44, p = 0.06), respectively. However, despite the deficiencies of robotic hepatectomy in terms of extended operation time compared to laparoscopic hepatectomy, robotic hepatectomy is still effective and equivalent to laparoscopic hepatectomy in outcomes. Scientific evaluation and research on one portion of the liver may produce more efficacity and more precise results. Therefore, more clinical trials are needed to evaluate the clinical outcomes of robotic compared to laparoscopic hepatectomy.

Minimally Invasive Hepatopancreatobiliary Surgery at a Large Regional Health System: Assessing the Safety of Program Expansion

“…This rate is higher than other studies, which have reported conversion rates of 0-12% for laparoscopic and 0-20% for robotic hepatic resections. [28][29][30][31][32][33][34] It should be noted that several of the studies listed did not specify the indication for resection, only laparoscopic vs robotic, when comparing conversion rates. Conversion to open resection typically occurs due to uncontrolled hemorrhage, difficulty achieving adequate oncologic resection, or general lack of progress in performing the procedure.…”

Prince and princesses: The current status of robotic surgery in surgical oncology

“…Conclusions from retrospective studies and meta‐analyses comparing RH to LH are more variable. For perioperative outcomes, RH requires a longer operative time but is consistently associated with a lower conversion rate than LH ( p < 0.001) 109–112 . In most other surgical procedures, a robotic approach is associated with decreased operative blood loss compared to a laparoscopic approach.…”

“…For perioperative outcomes, RH requires a longer operative time but is consistently associated with a lower conversion rate than LH (p < 0.001). [109][110][111][112] In most other surgical procedures, a robotic approach is associated with decreased operative blood loss compared to a laparoscopic approach. However, because there is currently no robotic Cavitron ® Ultrasonic Surgical Aspirator (CUSA) (Integra LifeSciences, Tullamore, Ireland), RH is mainly performed using the crush clamp technique, thus leading to higher operative blood loss.…”

“…109,113,114 There have been no differences seen in quality of oncologic resection, morbidity or mortality between RH and LH across multiple studies. [109][110][111][113][114][115] One NSQIP analysis reported higher rate of bile leak in RH during major and right hepatectomies. 116 Unlike in OH, there is no cost benefit for RH over LH.…”

“…However, because there is currently no robotic Cavitron® Ultrasonic Surgical Aspirator (CUSA) (Integra LifeSciences, Tullamore, Ireland), RH is mainly performed using the crush clamp technique, thus leading to higher operative blood loss 109,113,114 . There have been no differences seen in quality of oncologic resection, morbidity or mortality between RH and LH across multiple studies 109–111,113–115 116 .…”