Robotic and laparoscopic liver resection—comparative experiences at a high-volume German academic center

Abstract

Purpose Minimally invasive liver surgery (MILS) is a feasible and safe procedure for benign and malignant tumors. There has been an ongoing debate on whether conventional laparoscopic liver resection (LLR) or robotic liver resection (RLR) is superior and if one approach should be favored over the other. We started using LLR in 2010, and introduced RLR in 2013. In the present paper, we report on our experiences with these two techniques as early adopters in Germany. Methods The data of patients who underwent MILS between 2010 and 2020 were collected prospectively in the Magdeburg Registry for Minimally Invasive Liver Surgery (MD-MILS). A retrospective analysis was performed regarding patient demographics, tumor characteristics, and perioperative parameters. Results We identified 155 patients fulfilling the inclusion criteria. Of these, 111 (71.6%) underwent LLR and 44 (29.4%) received RLR. After excluding cystic lesions, 113 cases were used for the analysis of perioperative parameters. Resected specimens were significantly bigger in the RLR vs. the LLR group (405 g vs. 169 g, p = 0.002); in addition, the tumor diameter was significantly larger in the RLR vs. the LLR group (5.6 cm vs. 3.7 cm, p = 0.001). Hence, the amount of major liver resections (three or more segments) was significantly higher in the RLR vs. the LLR group (39.0% vs. 16.7%, p = 0.005). The mean operative time was significantly longer in the RLR vs. the LLR group (331 min vs. 181 min, p = 0.0001). The postoperative hospital stay was significantly longer in the RLR vs. the LLR group (13.4 vs. LLR 8.7 days, p = 0.03). The R0 resection rate for solid tumors was higher in the RLR vs. the LLR group but without statistical significance (93.8% vs. 87.9%, p = 0.48). The postoperative morbidity ≥ Clavien-Dindo grade 3 was 5.6% in the LLR vs. 17.1% in the RLR group (p = 0.1). No patient died in the RLR but two patients (2.8%) died in the LLR group, 30 and 90 days after surgery (p = 0.53). Conclusion Minimally invasive liver surgery is safe and feasible. Robotic and laparoscopic liver surgery shows similar and adequate perioperative oncological results for selected patients. RLR might be advantageous for more advanced and technically challenging procedures.

Study: International Multicentric Minimally Invasive Liver Resection for Colorectal Liver Metastases (SIMMILR-CRLM)

“…Clavien-Dindo complications of grade 3 and above occurred in 4-6% of the laparoscopic patients, 0-22% in the robotic cohort and 25-35% in the open cohort and, although this difference was statistically significant only when the LLR was compared to the OLR group, these rates are well within the range published in the literature of 5-55% after laparoscopic hepatectomy, 17-20% after robotic resection and 17-61% after open hepatectomy [33,35,36]. The major cause of morbidity after major liver resection is bile leak with 13.5% of patients after major hepatectomy found to have a bile leak in one study [37].…”

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

“…Nineteen studies [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ] elucidated the outcomes of robotic and laparoscopic surgery, with 682 and 1101 patients, respectively. The characteristics of studies included in the meta-analysis are shown in ( Table 1 and Table 2 ).…”

Robotic-Assisted Surgery for Primary Hepatobiliary Tumors—Possibilities and Limitations

“…Interestingly, the authors state that in Taiwan, costs for inpatient care are lower, because of the national reimbursement system, thus overshadowing the cost-benefit of shorter LOS, negatively affecting the total costs of RLR compared to nations spending more money on inpatient care [ 87 ]. In Germany, the healthcare system predefines the postoperative stay for reimbursement, thus influencing total costs [ 88 ].…”