Robotic Minor hepatectomy offers a Favorable Learning Curve and May Result in Superior Perioperative Outcomes Compared with Laparoscopic Approach

Abstract

Minorhepatectomy (MH) is a common type of robotic-assisted liver resection, but few studies compared it with laparoscopic. We compared the perioperative outcomes of patients who underwent robotic (RH) or laparoscopic (LH) minor hepatectomy and evaluated the effect of surgeon's experience on outcomes. A prospective database was used to identify patients from 2009 through 2016 who underwent RH or LH. Two surgeons performed RH starting in 2014, whereas LH had been established before that. Of the 93 patients, 42 were in RH and 51 in LH group. The mean patient age, gender, race, American Society of Anesthesiologists score, proportion of patients with cirrhosis and hepatocellular carcinoma were similar. Operative time, estimated blood loss (EBL), conversion to open, 30-day complication rate, Clavien–Dindo grade ≥ 3 complications, and length of hospital stay (LOS) were similar. There was no difference in average tumor size, specimen volume, or achievement of R0 margin. In RH group, after completing 15 cases, there were no conversions to open. After 25 cases, EBL, LOS, and 30-day complication rate were improved as compared with LH. Perioperative outcomes of robotic MH are equivalent to laparoscopic. After approximately 25 cases, robotic-assisted MH may result in superior outcomes compared with laparoscopic.

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

“…Furthermore, another paper advised to overcome the learning curve of RLR before embarking on using robotic major liver resection for cases of malignant disease [ 26 ] in order to ensure patients’ safety, a reduced operative time, a reduced blood loss, and a high oncological quality. Two studies showed that after 25–30 robotic liver resections, the achieved perioperative outcomes might be superior to LLR [ 27 , 28 ]. However, it has to be noted that these results might depend on the surgeon’s previous experience in laparoscopic liver surgery.…”

First two-stage robotic ALPPS in HCC patients with hepatic vein invasion: a step-by-step procedure from a clinical case

“…The Da Vinci robotic surgery system can provide a better surgical field and flexible robot arms, reducing the difficulty of surgery and better avoiding damage to bile ducts and important blood vessels during the process of portal vein ligation and liver parenchymal detachment [ 15 ]. The perioperative outcomes of robotic hepatectomy are equivalent to those of laparoscopic hepatectomy and may even result in superior outcomes compared with laparoscopic hepatectomy [ 16 ].…”

Robotics in HPB surgery

“…Results from randomised trials comparing laparoscopic vs open for hemi-hepatectomies (ORANGE-II PLUS) are awaited. Occun et al 48 provide a valuable review of the 14 major series (9 or more patients) of robotic liver surgery up until 2015, including all types of liver resections (major and minor) 2,39,42-44,49-57 -the big-gest, with 70 robotic liver resections, coming from Giulianotti et al 43 Since this review, a further 6 series have been published, 41,45,[58][59][60][61] totalling 627 patients of which 145 (23.1%) were for major liver resections. Some of these studies were matched with laparoscopic surgery 39,42,44,49,50,53,56,57,[59][60][61] and have shown generally comparable outcomes for blood loss, LOS, R 0 rate, operation time, morbidity and mortality.…”