Reasons for open conversion in robotic liver surgery: A systematic review with pooled analysis of more than 1000 patients

Gheza, Federico; Esposito, Sofia; Gruessner, Stephan; Mangano, Alberto; Fernandes, Eduardo; Giulianotti, Pier Cristoforo

doi:10.1002/rcs.1976

Cited by 15 publications

(5 citation statements)

References 42 publications

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“…Our results showed that RALR had a tendency for a lower conversion rate than LLR (4.7% vs. 10.5%). Although no significant differences in the conversion rates have been reported between RALR and LLR [37,56], a recent systematic review and two international multicenter retrospective analyses showed a significant reduction of conversion in RALR when compared with LLR [57][58][59]. Similar results were also reported by Fagenson et al by using the NSQIP database [60].…”

Section: Discussionsupporting

confidence: 65%

Perioperative outcomes of robot-assisted versus laparoscopic liver resection for cavernous hemangioma: a propensity score matching study

et al. 2023

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Background Minimally invasive techniques have increasingly been adopted for liver resection. This study aimed to compare the perioperative outcomes of robot-assisted liver resection (RALR) with laparoscopic liver resection (LLR) for liver cavernous hemangioma and to evaluate the treatment feasibility and safety. Methods A retrospective study of prospectively collected data was conducted on consecutive patients who underwent RALR (n = 43) and LLR (n = 244) for liver cavernous hemangioma between February 2015 and June 2021 at our institution. Patient demographics, tumor characteristics, and intraoperative and postoperative outcomes were analyzed and compared using propensity score matching. Results The postoperative hospital stay was significantly shorter (P = 0.016) in the RALR group. There were no significant differences between the two groups in overall operative time, intraoperative blood loss, blood transfusion rates, conversion to open surgery or complication rates. There was no perioperative mortality. Multivariate analysis showed that hemangiomas located in posterosuperior liver segments and those in close proximity to major vascular structures were independent predictors of increased intraoperative blood loss (P = 0.013 and P = 0.001, respectively). For patients with hemangioma in close proximity to major vascular structures, there were no significant differences in perioperative outcomes between the two groups, with the exception that intraoperative blood loss in the RALR group was significantly less than that in the LLR group (350 ml vs. 450 ml, P = 0.044). Conclusions Both RALR and LLR were safe and feasible for treating liver hemangioma in well-selected patients. For patients with liver hemangioma in close proximity to major vascular structures, RALR was better than conventional laparoscopic surgery in reducing intraoperative blood loss.

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Section: Discussionsupporting

confidence: 65%

Perioperative outcomes of robot-assisted versus laparoscopic liver resection for cavernous hemangioma: a propensity score matching study

et al. 2023

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“…In the development phase of robotic liver surgery, conversion rates as high as 10% were reported. In the recent literature, conversion rates of 5% after completion of the learning curve are reported, which is lower than the conversion rates reported for laparoscopic liver surgery [ 51 , 52 ]. Robotic surgical platforms especially seem to offer a benefit for the resection of lesions in the posterosuperior segments, which are relatively difficult to reach, and major liver resections [ 27 , 33 ].…”

Section: Intraoperative Outcomesmentioning

confidence: 87%

What Is the Current Role and What Are the Prospects of the Robotic Approach in Liver Surgery?

Bozkurt

Sijberden

Hilal

2022

Cancers

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In parallel with the historical development of minimally invasive surgery, the laparoscopic and robotic approaches are now frequently utilized to perform major abdominal surgical procedures. Nevertheless, the role of the robotic approach in liver surgery is still controversial, and a standardized, safe technique has not been defined yet. This review aims to summarize the currently available evidence and prospects of robotic liver surgery. Minimally invasive liver surgery has been extensively associated with benefits, in terms of less blood loss, and lower complication rates, including liver-specific complications such as clinically relevant bile leakage and post hepatectomy liver failure, when compared to open liver surgery. Furthermore, comparable R0 resection rates to open liver surgery have been reported, thus, demonstrating the safety and oncological efficiency of the minimally invasive approach. However, whether robotic liver surgery has merits over laparoscopic liver surgery is still a matter of debate. In the current literature, robotic liver surgery has mainly been associated with non-inferior outcomes compared to laparoscopy, although it is suggested that the robotic approach has a shorter learning curve, lower conversion rates, and less intraoperative blood loss. Robotic surgical systems offer a more realistic image with integrated 3D systems. In addition, the improved dexterity offered by robotic surgical systems can lead to improved intra and postoperative outcomes. In the future, integrated and improved haptic feedback mechanisms, artificial intelligence, and the introduction of more liver-specific dissectors will likely be implemented, further enhancing the robots’ abilities.

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“…Robotic liver surgery is a new technology involving invasive surgical practice integrating laparoscopic surgeries with distant robotic control of tools and by a support patient and patient-side surgeon. This study entailed reports of around 200 patients who undertook liver resection surgeries [7]. The reported rates of complications and conversion were 20.3% and 4.6%, respectively, due to underestimation from publication and selection biases [8].…”

Section: Discussionmentioning

confidence: 99%

Hepatectomy in Robotic Surgery

Coco

Leanza

2020

Open Access Maced J Med Sci

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Scientists developed the robotic surgery system to offer a solution to the increased challenges of conventional laparoscopic surgery. Robotic surgery is a minimally invasive surgical procedure, but scientists have not yet validated it. Over recent years, the use of the laparoscopic technique for liver surgery has reduced like other abdominal techniques due to the limitations of laparoscopic instruments. Robotic procedures can help surgeons to overcome these challenges, particularly during complex operations. Researchers conducted a review of major hepatic surgery on PubMed using designated keywords. They analyzed 237 patients in 17 series and recorded outcomes, for example, length of hospital stays, estimated loss of blood, duration of operation, costs, conversation rate, and related difficulties. The study indicated wedge resection and segmentectomy which were mainly performed procedures. However, the predominance of significant hepatectomies through robotic surgery has high chances because of the superior activities obtained by the robotic system. The complication and conversation rates were 13.4% and 4.2%, respectively. Bile leaks and intracavitary fluid collections were the frequent occurring morbidities. The mean time for conducting the operation was 285 min, while the mean blood loss during the process was 50–280 ml. The mean post-operative duration the patient remained at the hospital was 7 days. The study did not record long-term and survival outcomes. A study conducted in Italy indicated that robotic liver surgery had gained increasing acceptance due to its significant advantage to both patients and operators. Operators have done over 100 robotic hepatic surgeries in Italy, where most robotic training facilities are active. Robotic surgery is safe and feasible in experienced hands. More research is necessary to evaluate the improvement in long-term oncological follow-up and outcomes.

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Reasons for open conversion in robotic liver surgery: A systematic review with pooled analysis of more than 1000 patients

Cited by 15 publications

References 42 publications

Perioperative outcomes of robot-assisted versus laparoscopic liver resection for cavernous hemangioma: a propensity score matching study

Perioperative outcomes of robot-assisted versus laparoscopic liver resection for cavernous hemangioma: a propensity score matching study

What Is the Current Role and What Are the Prospects of the Robotic Approach in Liver Surgery?

Hepatectomy in Robotic Surgery

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