Robotic versus laparoscopic hepatectomy: application of the difficulty scoring system

Chong, Charing C.N.; Lok, Hon Ting; Fung, A.; Fong, Angie; Cheung, Yu‐San; Wong, John W.; Lee, K F; Lai, Paul B.S.

doi:10.1007/s00464-019-06976-8

Cited by 52 publications

(49 citation statements)

References 20 publications

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“…An analysis of the ACS-NSQIP data showed that major liver resection was one of the risk factors for open conversion during minimally invasive procedures, and robotic systems wereassociated with a lower conversion rate than laparoscopic liver resection 20. Recently, Chong et al21 reported that robotic systems allowed major hepatectomy or highly scoredhepatectomy to be performed with a minimally invasive approach. In our series, the procedures of all kinds of major liver resections, including mobilization of the right and left liver, individual ligation of the liver hilum, the extra-hepatic glissionean approach and parenchymal transection following the ischemic demarcation line, were all safely reproduced in the laparoscopic field using the robotic system.…”

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confidence: 99%

Robotic major liver resections: Surgical outcomes compared with open major liver resections

Yang

Rho

Han

et al. 2021

Ann Hepatobiliary Pancreat Surg

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Backgrounds/Aims: Laparoscopic major liver resections are still considered innovative procedures despite the recent development of laparoscopic liver surgery. Robotic surgery has been introduced as an innovative system for laparoscopic surgery. In this study, we investigated surgical outcomes after major liver resections using robotic systems. Methods: From January 2009 to October 2018, 70 patients underwent robotic major liver resections, which included conventional major liver resections and right sectionectomy. The short-term and long-term outcomes were compared with 252 open major resections performed during the same period. Results: Operative time was longer in the robotic group (472 min vs. 349 min, p＜0.001). However, estimated blood loss was lower in the robotic group compared with the open resection group (269 ml vs. 548 ml, p=0.009). The overall postoperative complication rate of the robotic group was lower than that of the open resection group (31.4% vs. 58.3%, p＜0.001), but the major complication rate was similar between the two groups. Hospital stay was shorter in the robotic group (9.5 days vs. 15.1 days, p=0.006). Among patients with HCC, cholangiocarcinoma, and colorectal liver metastasis, there was no difference in overall and disease-free survival between the two groups. After propensity score matching in 37 patients with HCC for each group, the robotic group still showed a shorter hospital stay and comparable long-term outcomes. Conclusions: Robotic major liver resections provided improved perioperative outcomes and comparable long-term oncologic outcome compared with open resections. Therefore, robotic surgery should be considered one of the options for minimally invasive major liver resections.

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mentioning

confidence: 99%

Robotic major liver resections: Surgical outcomes compared with open major liver resections

Yang

Rho

Han

et al. 2021

Ann Hepatobiliary Pancreat Surg

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“…32 Subsequently, several large series from expert centres were reported on robotic pancreatectomies 25,33 and robotic hepatectomies. 34,35 RHPBS was adopted to overcome the limitations of conventional laparoscopy and to shorten the long and steep learning curve associated with laparoscopic hepatectomies and pancreatectomy. 36 Nonetheless, despite its many theoretical advantages, RHPBS remains a technically challenging procedure especially during the early learning phase.…”

Section: Discussionmentioning

confidence: 99%

Adoption of Robotic Liver, Pancreatic and Biliary Surgery in Singapore: A Single Institution Experience with Its First 100 Consecutive Cases

Goh

Low

Teo

et al. 2020

Ann Acad Med Singap

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Introduction: Presently, robotic hepatopancreatobiliary surgery (RHPBS) is increasingly adopted worldwide. This study reports our experience with the first 100 consecutive cases of RHPBS in Singapore. Methods: Retrospective review of a single-institution prospective database of the first 100 consecutive RHPBS performed over 6 years from February 2013 to February 2019. Eighty-six cases were performed by a single surgeon. Results: The 100 consecutive cases included 24 isolated liver resections, 48 pancreatic surgeries (including 2 bile duct resections) and 28 biliary surgeries (including 8 with concomitant liver resections). They included 10 major hepatectomies, 15 pancreaticoduodenectomies, 6 radical resections for gallbladder carcinoma and 8 hepaticojejunostomies. The median operation time was 383 minutes, with interquartile range (IQR) of 258 minutes and there were 2 open conversions. The median blood loss was 200ml (IQR 350ml) and 15 patients required intra-operative blood transfusion. There were no post-operative 90-day nor in-hospital mortalities but 5 patients experienced major (> grade 3a) morbidities. The median post-operative stay was 6 days (IQR 5 days) and there were 12 post-operative 30-day readmissions. Comparison between the first 50 and the subsequent 50 patients demonstrated a significant reduction in blood loss, significantly lower proportion of malignant indications, and a decreasing frequency in liver resections performed. Conclusion: Our experience with the first 100 consecutive cases of RHPBS confirms its feasibility and safety when performed by experienced laparoscopic hepatopancreatobiliary surgeons. It can be performed for even highly complicated major hepatopancreatobiliary surgery with a low open conversion rate. Keywords: Biliary surgery, hepaticojejunostomy, liver resection, pancreas, pancreaticoduodenectomy

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“…Among the 29 studies collected, the median value of EBL was 200 mL (range 25-495) and the median operative time was 260.65 min (range 107-491). Chong et al [1] reported results of resections differentiated by difficulty scoring system (DSS). The authors confirmed a correlation between DSS and EBL and operative time.…”

Section: Surgery Related Factorsmentioning

confidence: 99%

“…However, Hu et al [13] established that RS could be the best choice to treat complex cases of LLS (tumor size > 10 cm in diameter, proximity of the tumor to major vessels, BMI > 30 kg/m 2 , combined lymphadenectomy or choledochoscopy, huge left lateral section embedded in splenic fossa), reporting significantly lower EBL than in laparoscopy for these cases (131.9 mL vs. 320.8 mL, respectively). [1] 91 92 LS, Sg1 LS, Sg1…”

Section: Left Lateral Sectionectomymentioning

confidence: 99%

“…The advantages of RS are several: it provides increased surgical dexterity and enhanced suturing ability, thanks to a magnified three-dimensional view of the operative field, hand tremor filtration and articulating instruments with seven-degrees of freedom. Furthermore, this approach reduces significantly surgeons' fatigue, improving performances for long operations [1,2] . In addition, RS supports and upgrades the technology of specific surgical tools, that can help surgeons to face challenging situations and improve surgical results, such as with intraoperative ultrasound, near-infrared fluorescence with indocyanine green, CT and MR images integrated into the robotic console.…”

Section: Introductionmentioning

confidence: 99%

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Robotic liver surgery: literature review and current evidence

Ruzzenente¹,

Alaimo²,

Conci³

et al. 2020

Mini-invasive Surg

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In the field of minimally invasive surgery, robotic surgery (RS) was introduced to overcome drawbacks in laparoscopic surgery. However, its clinical application in hepatobiliary surgery is not yet standardized. This review analyzed the results of RS to clarify the benefits of robotic liver surgery in comparison with standard laparoscopy. Among 112 publications found in the literature, the 72 most relevant were selected and the following data were extracted: patients characteristics, operative procedures, histopathology, short-term and long-term outcomes, and costs. Twenty-nine articles on robotic liver resections, published in the last five years (2015-2020) and including 1831 patients, were analyzed. Twenty-five comparative studies between robotic and laparoscopic surgery were evaluated to underline the differences in operative outcomes. Eventually, 4 sub-group analyses were conducted on hepatocellular carcinoma, gallbladder cancer, hilar cholangiocarcinoma, and colorectal liver metastases. Almost all the authors reported data on safety, feasibility and oncologic effectiveness of RS reaching comparable results with laparoscopy. However, even if robotic surgery showed longer operative time and higher costs, in selected cases it allowed to increase the rate of minimally invasive approach when compared with laparoscopy. Thus, both open and minimally invasive surgery should be provided in a modern hepatobiliary center, including the robotic approach particularly to complex cases, otherwise very demanding by laparoscopy. In conclusion, different techniques should be tailored to each patient, choosing the minimally invasive approach when possible, enhancing patients’ recovery after surgery, especially in cirrhotic livers and in the context of liver transplantation. Although many centers experienced robotic liver surgery, more and larger studies are necessary to define its real benefits relative to laparoscopy, in order to standardize patient selection criteria and techniques.

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Robotic versus laparoscopic hepatectomy: application of the difficulty scoring system

Cited by 52 publications

References 20 publications

Robotic major liver resections: Surgical outcomes compared with open major liver resections

Robotic major liver resections: Surgical outcomes compared with open major liver resections

Adoption of Robotic Liver, Pancreatic and Biliary Surgery in Singapore: A Single Institution Experience with Its First 100 Consecutive Cases

Robotic liver surgery: literature review and current evidence

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