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Thomas MN, Schmidt T, Fuchs H, Stippel D, Wagner T, Hummels M, Buchner D, Hiort M, Kraus D, Bruns CJ. [Robotic liver surgery]. CHIRURGIE (HEIDELBERG, GERMANY) 2025; 96:607-615. [PMID: 40343449 DOI: 10.1007/s00104-025-02268-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/12/2025] [Indexed: 05/11/2025]
Abstract
Minimally invasive surgery is currently undergoing a paradigm shift from the classical laparoscopic approach to robot-assisted minimally invasive surgery. Robotic surgery has made significant progress in various surgical disciplines in recent years and is increasingly being used. This is due to the increasing clinical availability of robotic systems as well as better visualization, an increased surgical precision and a higher degree of freedom of the robotic instruments used, compared to classical laparoscopy, resulting in a flatter learning curve and better ergonomics for the surgeon. This article examines the current status of robot-assisted liver surgery, highlights the technical and clinical challenges and discusses future perspectives and potential developments in this dynamic field.
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Affiliation(s)
- Michael N Thomas
- Klinik für Allgemeine‑, Viszeral‑, Thorax- und Transplantationschirurgie, Uniklinik Köln, Kerpener Straße 62, 50937, Köln, Deutschland.
| | - Thomas Schmidt
- Klinik für Allgemeine‑, Viszeral‑, Thorax- und Transplantationschirurgie, Uniklinik Köln, Kerpener Straße 62, 50937, Köln, Deutschland
| | - Hans Fuchs
- Klinik für Allgemeine‑, Viszeral‑, Thorax- und Transplantationschirurgie, Uniklinik Köln, Kerpener Straße 62, 50937, Köln, Deutschland
| | - Dirk Stippel
- Klinik für Allgemeine‑, Viszeral‑, Thorax- und Transplantationschirurgie, Uniklinik Köln, Kerpener Straße 62, 50937, Köln, Deutschland
| | - Tristan Wagner
- Klinik für Allgemeine‑, Viszeral‑, Thorax- und Transplantationschirurgie, Uniklinik Köln, Kerpener Straße 62, 50937, Köln, Deutschland
| | - Marielle Hummels
- Klinik für Allgemeine‑, Viszeral‑, Thorax- und Transplantationschirurgie, Uniklinik Köln, Kerpener Straße 62, 50937, Köln, Deutschland
| | - Denise Buchner
- Klinik für Allgemeine‑, Viszeral‑, Thorax- und Transplantationschirurgie, Uniklinik Köln, Kerpener Straße 62, 50937, Köln, Deutschland
| | - Mirka Hiort
- Klinik für Allgemeine‑, Viszeral‑, Thorax- und Transplantationschirurgie, Uniklinik Köln, Kerpener Straße 62, 50937, Köln, Deutschland
| | - Dolores Kraus
- Klinik für Allgemeine‑, Viszeral‑, Thorax- und Transplantationschirurgie, Uniklinik Köln, Kerpener Straße 62, 50937, Köln, Deutschland
| | - Christiane J Bruns
- Klinik für Allgemeine‑, Viszeral‑, Thorax- und Transplantationschirurgie, Uniklinik Köln, Kerpener Straße 62, 50937, Köln, Deutschland
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Wang P, Zhang D, Huang B, Zhou WH, Wang CS, Zhao SY, Su S, Jiang XZ. Robotic versus laparoscopic hepatectomy: meta-analysis of propensity-score matched studies. BJS Open 2025; 9:zrae141. [PMID: 40164991 PMCID: PMC11957917 DOI: 10.1093/bjsopen/zrae141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 07/04/2024] [Accepted: 07/25/2024] [Indexed: 04/02/2025] Open
Abstract
BACKGROUND Robotic techniques can theoretically overcome the limitations of laparoscopic liver resection and are currently recognized as safe options; however, it is not known which approach is better. The purpose of this study was to compare the advantages of robotic hepatectomy and laparoscopic hepatectomy. METHODS Electronic databases (the Cochrane Library, PubMed (MEDLINE), Embase and Web of Science) were systematically searched from January 2000 to August 2023 for eligible studies that compared robotic hepatectomy and laparoscopic hepatectomy. Studies that met the inclusion criteria were then reviewed systematically. The reported data were aggregated statistically using RevMan 5.4 software. The parameters of interest included intraoperative, postoperative, survival and financial outcomes. Subgroup analysis was performed according to the type and difficulty level of hepatectomy and the study setting. RESULTS A total of 26 propensity-score matching comparative trials met the inclusion criteria, which comprised 9355 participants (robotic hepatectomy versus laparoscopic hepatectomy: 3938 versus 5417) in the meta-analysis. For surgical outcomes, lower blood loss, lower open conversion rate and higher R0 resection rate were observed in the robotic hepatectomy group compared with the laparoscopic hepatectomy group (mean difference (MD) -86.22, 95% c.i. -116.49 to -55.95, I² = 87%, P < 0.001; OR 0.51, 95% c.i. 0.38 to 0.69, I² = 40%, P < 0.001; OR 1.31, 95% c.i. 1.03 to 1.67, I² = 0%, P = 0.030 respectively). The lower blood loss (major hepatectomy group: MD -56.88, 95% c.i. -109.09 to -4.28, I² = 76%, P = 0.030; IWATE score (advanced/expert more than 80%) group: MD -0.61, 95% c.i. -1.14 to -0.08, I² = 95%, P < 0.001) and lower open conversion rate (major hepatectomy group: OR 0.41, 95% c.i. 0.30 to 0.56, I² = 0%, P < 0.001; IWATE score (advanced/expert less than 80%) group: OR 0.52, 95% c.i. 0.36 to 0.75, I² = 0%, P = 0.659) advantage persisted across subgroup analyses. CONCLUSION The robotic approach had advantages to laparoscopic in terms of lower blood loss and reduced rates of open conversion, especially in difficult hepatectomies.
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Affiliation(s)
- Piao Wang
- Department of Hepatobiliary and Pancreatic Surgery, The Second People’s Hospital of Yibin, Yibin, Sichuan, China
| | - Dan Zhang
- Department of Thyroid and Breast Surgery, The Third People’s Hospital of Yibin, Yibin, Sichuan, China
| | - Bin Huang
- Department of Hepatobiliary and Pancreatic Surgery, The Second People’s Hospital of Yibin, Yibin, Sichuan, China
| | - Wen-Hao Zhou
- Department of Hepatobiliary and Pancreatic Surgery, The Second People’s Hospital of Yibin, Yibin, Sichuan, China
| | - Chang-Song Wang
- Department of Hepatobiliary and Pancreatic Surgery, The Second People’s Hospital of Yibin, Yibin, Sichuan, China
| | - Shao-Yong Zhao
- Department of Hepatobiliary and Pancreatic Surgery, The Second People’s Hospital of Yibin, Yibin, Sichuan, China
| | - Song Su
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Xiao-Zhong Jiang
- Department of Hepatobiliary and Pancreatic Surgery, The Second People’s Hospital of Yibin, Yibin, Sichuan, China
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Haugen C, Noriega M, Andy C, Waite C, Carpenter D, Halazun K, Samstein B, Rocca JP. Complete transition from laparoscopic to robotic liver surgery achieves superior outcomes in difficult hepatectomies: a seven-year retrospective study. Surg Endosc 2025; 39:1600-1608. [PMID: 39762602 DOI: 10.1007/s00464-024-11474-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Accepted: 12/01/2024] [Indexed: 03/03/2025]
Abstract
BACKGROUND Minimally invasive liver surgery (MILS) is superior to open surgery when considering decreased blood loss, fewer complications, shorter hospital stay, and similar or improved oncologic outcomes. However, operative limitations in laparoscopic hepatectomy have curved its applicability and momentum of complex minimally invasive liver surgery. Transitioning to robotic hepatectomy may bridge this complexity gap. METHODS Retrospective cohort study conducted on comparable hepatectomies (open, laparoscopic, robotic) for benign or malignant diseases at Weill Cornell by three surgeons from 2017 to 2023. Case volume and Iwate difficulty scoring were examined over time by surgical approach. Outcome associations (operative time, estimated blood loss, length of stay, 90-day complications, open conversion, and resection margin) were analyzed using generalized estimating equations to account for the hierarchical data structure of different surgeons and controlled for clinical covariates. RESULTS Among 353 hepatectomies, 112 were open (OH), 107 were laparoscopic (LH), and 134 were robotic (RH). OH patients were more likely to have malignant pathology (83% vs. LH 69%, RH 57%) and less likely to have cirrhosis (6% vs. LH 6%, RH 14%). OH and RH had similar case complexity (Median Iwate: OH 7 vs. RH 7). After adjustments, LH and RH had 39% and 43% shorter median lengths of stay, respectively, and 89% and 62% lower odds of complications compared to OH. RH had 87% lower odds of conversion to OH compared to LH. The odds of R0 resection were similar between LH, RH, and OH. These results remained consistent in high difficulty cases (Iwate 7-12). Over the study period, RH usage increased from 36 to 68%, while LH decreased from 39 to 9%. By 2023, RH was predominantly used over OH (74% vs.26%). CONCLUSION The transition from laparoscopic to all-robotic approach resulted in increased case volume and complexity in MILS, largely improving perioperative outcomes in hepatectomy.
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Affiliation(s)
- Christine Haugen
- Department of Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Mateo Noriega
- Department of Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Caroline Andy
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Carolyn Waite
- Department of Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Dustin Carpenter
- Department of Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Karim Halazun
- Department of Surgery, NYU Langone, New York, NY, USA
| | | | - Juan Pablo Rocca
- Department of Surgery, Weill Cornell Medicine, New York, NY, USA.
- Weill Cornell Medicine, 525 E. 68th Street, Payson 7th floor, New York, NY, 10065, USA.
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Niu F, Wang Y, Bai Z, He Z, Wang H, Li F. An updated meta-analysis of the efficacy and safety of robot-assisted laparoscopy hepatectomy and laparoscopic hepatectomy in the treatment of liver tumors. Medicine (Baltimore) 2025; 104:e40866. [PMID: 40184083 PMCID: PMC11709161 DOI: 10.1097/md.0000000000040866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Revised: 11/16/2024] [Accepted: 11/20/2024] [Indexed: 04/05/2025] Open
Abstract
BACKGROUND To compare the efficacy and safety of robot-assisted laparoscopic hepatectomy (RALH) with laparoscopic hepatectomy (LH) in the treatment of liver tumors. METHODS A comprehensive search of English-language literature was conducted in PubMed, Embase, Web of Science, and the Cochrane Library from January 2000 to June 2024. Studies comparing RALH and LH for liver tumors were identified, and after qualitative evaluation, a meta-analysis was performed using Stata 16.0 software. RESULTS After applying inclusion and exclusion criteria, 42 articles were included, including 29,969 patients, with 5673 in the RALH group and 24,296 in the LH group. The meta-analysis showed that compared with the LH group, surgery time was longer in the RALH group (MD = 55.33; 95% CI: 34.84-75.83; P < .001), the conversion to open surgery rate was higher (RR = 1.04; 95% CI: 1.03-1.05; P < .001), the total cost was higher (MD = 0.43; 95% CI: 0.14-0.73; P = .004), and the tumor diameter was larger (MD = 0.37; 95% CI: 0.24-0.49; P < .001). Additionally, the R1 resection rate was higher in the RALH group (RR = 1.04; 95% CI: 1.03-1.06; P < .001). However, there were no significant differences between the groups in terms of intraoperative transfusion rate, hepatic hilar occlusion rate, postoperative complications, postoperative hospital stay, mortality rate, malignancy rate, or R0 resection rate (P > .05). CONCLUSION Based on current evidence, RALH is safe and effective, although it is associated with higher total costs, increased blood transfusion rates, and longer operative times. However, there were no significant differences between RALH and LH in terms of other outcome indicators, suggesting that both procedures offer similar surgical efficacy and safety. Further clinical randomized controlled trials are needed to confirm these findings.
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Affiliation(s)
- Fuyong Niu
- Department of Hepatobiliary Surgery, The First Hospital of Yulin City, Yulin City, Shaanxi Province, China
| | - Yefei Wang
- Department of Hepatobiliary Surgery, The First Hospital of Yulin City, Yulin City, Shaanxi Province, China
| | - Zhiyuan Bai
- Department of Hepatobiliary Surgery, The First Hospital of Yulin City, Yulin City, Shaanxi Province, China
| | - Zhiqiang He
- Department of Hepatobiliary Surgery, The First Hospital of Yulin City, Yulin City, Shaanxi Province, China
| | - Hailin Wang
- Department of Hepatobiliary Surgery, The First Hospital of Yulin City, Yulin City, Shaanxi Province, China
| | - Furong Li
- Department of Hepatobiliary Surgery, The First Hospital of Yulin City, Yulin City, Shaanxi Province, China
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Long ZT, Li HJ, Liang H, Wu YC, Ameer S, Qu XL, Xiang ZQ, Wang Q, Dai XM, Zhu Z. Robotic versus laparoscopic liver resection for liver malignancy: a systematic review and meta-analysis of propensity score-matched studies. Surg Endosc 2024; 38:56-65. [PMID: 38017157 DOI: 10.1007/s00464-023-10561-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/23/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE How different surgical procedures, including the robotic-assisted liver resection (RLR) and laparoscopic liver resection (LLR), can affect the prognosis of patients with liver malignancies is unclear. Thus, in this study, we compared the effects of RLR and LLR on the surgical and oncological outcomes in patients with liver malignancies through propensity score-matched cohort studies. METHODS The PubMed, Embase, and Cochrane databases were searched using Medical Subject Headings terms and keywords from inception until May 31, 2023. The quality of the included studies was assessed using the Newcastle-Ottawa quality assessment scale. The mean difference with 95% confidence interval (95% CI) was used for analysis of continuous variables; the risk ratio with 95% CI was used for dichotomous variables; and the hazard ratio with 95% CI was used for survival-related variables. Meta-analysis was performed using a random-effects model. RESULTS Five high-quality cohort studies with 986 patients were included (370 and 616 cases for RLR and LLR, respectively). In terms of surgical outcomes, there were no significant differences in the operation time, conversion rate to open surgery, overall complication rate, major complication rate, and length of hospital stay between the RLR and LLR groups. In terms of oncological outcomes, there were no significant differences in the 5-year overall survival and disease-free survival between the two groups. CONCLUSION Surgical and oncological outcomes are comparable between RLR and LLR on patients with liver malignancies. Therefore, the benefits of applying RLR in patients with liver malignancies need to be further explored.
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Affiliation(s)
- Zhang-Tao Long
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Hua-Jian Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Hao Liang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Ya-Chen Wu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Sajid Ameer
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Xi-Lin Qu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Zhi-Qiang Xiang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Qian Wang
- Department of Reproductive Medicine, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China.
| | - Xiao-Ming Dai
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China.
| | - Zhu Zhu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China.
- Department of Education and Training, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China.
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Hays SB, Corvino G, Lorié BD, McMichael WV, Mehdi SA, Rieser C, Rojas AE, Hogg ME. Prince and princesses: The current status of robotic surgery in surgical oncology. J Surg Oncol 2024; 129:164-182. [PMID: 38031870 DOI: 10.1002/jso.27536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/11/2023] [Indexed: 12/01/2023]
Abstract
Robotic surgery has experienced a dramatic increase in utilization across general surgery over the last two decades, including in surgical oncology. Although urologists and gynecologists were the first to show that this technology could be utilized in cancer surgery, the robot is now a powerful tool in the treatment of gastrointestinal, hepato-pancreatico-biliary, colorectal, endocrine, and soft tissue malignancies. While long-term outcomes are still pending, short-term outcomes have showed promise for this technologic advancement of cancer surgery.
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Affiliation(s)
- Sarah B Hays
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Gaetano Corvino
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Benjamin D Lorié
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - William V McMichael
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Syed A Mehdi
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Caroline Rieser
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Aram E Rojas
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Melissa E Hogg
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
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Balzano E, Bernardi L, Roesel R, Vagelli F, Ghinolfi D, Tincani G, Catalano G, Melandro F, Petrusic A, Popeskou SG, Christoforidis D, Majno-Hurst P, De Simone P, Cristaudi A. Robotic versus laparoscopic liver resections: propensity-matched comparison of two-center experience. Surg Endosc 2023; 37:8123-8132. [PMID: 37721588 DOI: 10.1007/s00464-023-10358-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/30/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND The advantages of the robotic approach in minimally invasive liver surgery (MILS) are still debated. This study compares the short-term outcomes between laparoscopic (LLR) and robotic (RLR) liver resections in propensity score matched cohorts. METHODS Data regarding minimally invasive liver resections in two liver surgery units were retrospectively reviewed. A propensity score matched analysis (1:1 ratio) identified two groups of patients with similar characteristics. Intra- and post-operative outcomes were then compared. The difficulty of MILS was based on the IWATE criteria. RESULTS Two hundred sixty-nine patients underwent MILS between January 2014 and December 2021 (LLR = 192; RLR = 77). Propensity score matching identified 148 cases (LLR = 74; RLR = 74) consisting of compensated cirrhotic patients (100%) underwent non-anatomic resection of IWATE 1-2 class (90.5%) for a solitary tumor < 5 cm in diameter (93.2%). In such patients, RLRs had shorter operative time (227 vs. 250 min, p = 0.002), shorter Pringle's cumulative time (12 vs. 28 min, p < 0.0001), and less blood loss (137 vs. 209 cc, p = 0.006) vs. LLRs. Conversion rate was nihil (both groups). In RLRs compared to LLRs, R0 rate (93 vs. 96%, p > 0.71) and major morbidity (4.1 vs. 5.4%, p > 0.999) were similar, without post-operative mortality. Hospital stay was shorter in the robotic group (6.2 vs. 6.6, p = 0.0001). CONCLUSION This study supports the non-inferiority of RLR over LLR. In compensated cirrhotic patients underwent resection of low-to-intermediate difficulty for a solitary nodule < 5 cm, RLR was faster, with less blood loss despite the shorter hilar clamping, and required shorter hospitalization compared to LLR.
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Affiliation(s)
- Emanuele Balzano
- Hepato-Biliary Surgery and Liver Transplant Unit, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - Lorenzo Bernardi
- Department of Surgery, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Raffaello Roesel
- Department of Surgery, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Filippo Vagelli
- Hepato-Biliary Surgery and Liver Transplant Unit, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Davide Ghinolfi
- Hepato-Biliary Surgery and Liver Transplant Unit, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Giovanni Tincani
- Hepato-Biliary Surgery and Liver Transplant Unit, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Gabriele Catalano
- Hepato-Biliary Surgery and Liver Transplant Unit, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Fabio Melandro
- Hepato-Biliary Surgery and Liver Transplant Unit, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Antonietta Petrusic
- Department of Surgery, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | | | - Dimitri Christoforidis
- Department of Surgery, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Department of Biomedical Sciences, University of Southern Switzerland (USI), Lugano, Switzerland
| | - Pietro Majno-Hurst
- Department of Surgery, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Department of Biomedical Sciences, University of Southern Switzerland (USI), Lugano, Switzerland
| | - Paolo De Simone
- Hepato-Biliary Surgery and Liver Transplant Unit, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
- Department of Surgical, Medical, Biochemical Pathology and Intensive Care, University of Pisa, Pisa, Italy
| | - Alessandra Cristaudi
- Department of Surgery, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Department of Biomedical Sciences, University of Southern Switzerland (USI), Lugano, Switzerland
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Goodsell KE, Park JO. Robotic hepatectomy: current evidence and future directions. Minerva Surg 2023; 78:525-536. [PMID: 36946128 DOI: 10.23736/s2724-5691.23.09858-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Minimally invasive hepatectomy continues to gain popularity and acceptance for treatment of benign and malignant liver disease. Robotic hepatectomy offers potential advantages over open and conventional laparoscopic approaches. Review of the literature on robotic hepatectomy was performed. Search terms included "robotic hepatectomy" and "minimally invasive hepatectomy." Search was further customized to include articles related to robotic surgical technology. Across many parameters in liver surgery, robotic liver resection appears to have comparable outcomes with respect to laparoscopic resection. The benefits over open resection are largely related to less morbidity and faster recovery times. There is evidence that the robotic approach may have a shorter learning curve and enable more difficult resections to be performed minimally invasively. The robotic platform may have the potential to achieve superior margin status or parenchymal sparing resection in oncologic resections, but numerous obstacles remain. The robotic platform has not been applied to liver surgery to the same extent as either laparoscopic or open surgery. Robotic surgical technology will need to continue developing to deliver on its potential advantages.
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Affiliation(s)
| | - James O Park
- Department of Surgery, University of Washington, Seattle, WA, USA
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Maeda T, Liu J, Uchida H, Amano H, Shirota C, Tainaka T, Sumida W, Makita S, Takimoto A, Takada S, Nakagawa Y, Gouda A, Guo Y, Hinoki A. Robotic versus laparoscopic radical surgery for pediatric congenital biliary dilatation: a comparison of surgical outcomes of a single surgeon's initial experience. Pediatr Surg Int 2023; 39:261. [PMID: 37660350 DOI: 10.1007/s00383-023-05548-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE This study aimed to clarify the validity of robot-assisted surgery (RAS) for pediatric patients with congenital biliary dilatation (CBD). METHODS We retrospectively compared RAS and laparoscopic surgery (LS) for pediatric CBD performed by the same certified surgeon between 2016 and 2022. RESULTS We included 6 RAS and 12 LS cases in this study. One case of RAS with laparotomy was excluded from the analysis. The patients in the two groups had comparable ages and body weights. The median surgery duration, the suture time per stitch, and the time to drain removal were 385 min, 145 s, and 5 days in the RAS group and 370 min (p = 0.28), 177 s (p = 0.03), and 6 days (p = 0.03) in the LS group, respectively. The time to create the Roux-en-Y limb was significantly longer in the RAS group. Postoperative complications occurred in one RAS case and in four LS cases. CONCLUSIONS Less anastomotic time per stitch and less time to drain removal suggest that RAS may contribute to accurate suturing and fine intra-pancreatic bile duct dissection. In addition, RAS requiring large movements of forceps in a large surgical field, such as Roux-en-Y creation, is inferior to LS.
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Affiliation(s)
- Takuya Maeda
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Jiahui Liu
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Hizuru Amano
- Department of Rare/Intractable Cancer Analysis Research, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Chiyoe Shirota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takahisa Tainaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Wataru Sumida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Satoshi Makita
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Aitaro Takimoto
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shunya Takada
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yoichi Nakagawa
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Akihiro Gouda
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yaohui Guo
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Akinari Hinoki
- Department of Rare/Intractable Cancer Analysis Research, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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10
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Chen A, Tsai KY, Wang WY, Chen HA, Huang MT. Robotic versus laparoscopic hepatectomy: A single-center, propensity score- matched study. Asian J Surg 2023; 46:3593-3600. [PMID: 37537065 DOI: 10.1016/j.asjsur.2023.07.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 07/01/2023] [Accepted: 07/09/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Although the effectiveness of robotic hepatectomy (RH) has been evaluated in several studies, the superiority of RH over other approaches has not been definitely established. Therefore, in the present propensity score-matched cohort study, we compared RH and laparoscopic hepatectomy (LH) in terms of perioperative and oncologic outcomes. METHODS This retrospective study included patients who underwent RH or LH for benign and malignant liver lesions at a single center in Taiwan at any time between 2014 and 2020. Confounding factors, specifically age, sex, body mass index, American Society of Anesthesiologists score, IWATE criteria, and Charlson comorbidity index, were adjusted through propensity score matching (PSM). RESULTS A total of 329 patients were finally included in this study. Two homogeneous groups (RH and LH; n, 72 each) were formed using PSM. The RH group had a longer operative time (median: 231 vs.180 min, respectively; P = .001) and lower conversion (to open surgery) rate (9.7% vs.0.0%, respectively; P = .013) than did the LH group. However, the two groups did not differ in terms of other perioperative outcomes, specifically blood loss, hospital stay, intensive care unit admission, mortality, morbidity, or tumor margin status. CONCLUSIONS The rate of conversion to open surgery is lower in RH than in LH. Although operative time is longer in RH than in LH, RH is feasible and safe for patients with benign or malignant liver lesion. Our study also demonstrated comparable oncological results in patients with hepatocellular carcinoma between LH and RH group.
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Affiliation(s)
- Alvin Chen
- Division of General Surgery, Department of Surgery, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.
| | - Kuei-Yen Tsai
- Division of General Surgery, Department of Surgery, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wan-Yu Wang
- Division of General Surgery, Department of Surgery, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Hsin-An Chen
- Division of General Surgery, Department of Surgery, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ming-Te Huang
- Division of General Surgery, Xin Tai General Hospital, Taiwan
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11
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Heinrich S, Tschuor C, Lang H. [Robotics in Liver Surgery - Tips and Tricks]. Zentralbl Chir 2023; 148:359-366. [PMID: 37130543 DOI: 10.1055/a-2060-9814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Since minimally invasive liver surgery has proven benefits over open surgery, this technique should also be implemented more broadly in Germany. With the dramatic development in minimally invasive and robotic liver surgery, this approach has been established in recent years. Most recent analyses suggest lower complication rates, blood loss and hospital stay compared to open and laparoscopic liver surgery. In contrast to laparoscopic surgery, the technical setting of robotic liver surgery is widely independent of the type of resection. The laparoscopic and robotic technologies should be considered to be equal at the moment, although most recent analyses even suggest additional advantages of robotic over laparoscopic liver surgery. Moreover, robotics has a greater potential for technical refinements, including the inclusion of artificial intelligence and machine learning. Most steps can be transferred from open and laparoscopic liver surgery, but a dissection device such as the CUSA has not yet been developed. Consequently, different techniques have been reported for parenchymal transsection. Due to the special technical features of robotic surgery, intensive training programs should be used prior to the establishment of a robotic liver surgery program.
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Affiliation(s)
- Stefan Heinrich
- Department of General, Visceral and Transplantation Surgery, University Hospital Center Mainz, Mainz, Deutschland
| | - Christoph Tschuor
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hauke Lang
- Department of General, Visceral and Transplantation Surgery, University Hospital Center Mainz, Mainz, Deutschland
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12
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Kwak BJ, Lee JH, Chin KM, Syn NL, Choi SH, Cheung TT, Chiow AKH, Sucandy I, Marino MV, Prieto M, Chong CC, Choi GH, Efanov M, Kingham TP, Sutcliffe RP, Troisi RI, Pratschke J, Wang X, D'Hondt M, Tang CN, Mishima K, Wakabayashi G, Cherqui D, Aghayan DL, Edwin B, Scatton O, Sugioka A, Long TCD, Fondevila C, Alzoubi M, Hilal MA, Ruzzenente A, Ferrero A, Herman P, Lee B, Fuks D, Cipriani F, Liu Q, Aldrighetti L, Liu R, Han HS, Goh BKP. Robotic versus laparoscopic liver resections for hepatolithiasis: an international multicenter propensity score matched analysis. Surg Endosc 2023; 37:5855-5864. [PMID: 37067594 DOI: 10.1007/s00464-023-10051-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 03/26/2023] [Indexed: 04/18/2023]
Abstract
INTRODUCTION Minimally invasive liver resection (MILR) is widely recognized as a safe and beneficial procedure in the treatment of both malignant and benign liver diseases. Hepatolithiasis has traditionally been reported to be endemic only in East Asia, but has seen a worldwide uptrend in recent decades with increasingly frequent and invasive endoscopic instrumentation of the biliary tract for a myriad of conditions. To date, there has been a woeful lack of high-quality evidence comparing the laparoscopic (LLR) and robotic (RLR) approaches to treatment hepatolithiasis. METHODS This is an international multicenter retrospective analysis of 273 patients who underwent RLR or LRR for hepatolithiasis at 33 centers in 2003-2020. The baseline clinicopathological characteristics and perioperative outcomes of these patients were assessed. To minimize selection bias, 1:1 (48 and 48 cases of RLR and LLR, respectively) and 1:2 (37 and 74 cases of RLR and LLR, respectively) propensity score matching (PSM) was performed. RESULTS In the unmatched cohort, 63 (23.1%) patients underwent RLR, and 210 (76.9%) patients underwent LLR. Patient clinicopathological characteristics were comparable between the groups after PSM. After 1:1 and 1:2 PSM, RLR was associated with less blood loss (p = 0.003 in 1:2 PSM; p = 0.005 in 1:1 PSM), less patients with blood loss greater than 300 ml (p = 0.024 in 1:2 PSM; p = 0.027 in 1:1 PSM), and lower conversion rate to open surgery (p = 0.003 in 1:2 PSM; p < 0.001 in 1:1 PSM). There was no significant difference between RLR and LLR in use of the Pringle maneuver, median Pringle maneuver duration, 30-day readmission rate, postoperative morbidity, major morbidity, reoperation, and mortality. CONCLUSION Both RLR and LLR were safe and feasible for hepatolithiasis. RLR was associated with significantly less blood loss and lower open conversion rate.
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Affiliation(s)
- Bong Jun Kwak
- Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Hoon Lee
- Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ken Min Chin
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore
| | - Nicholas L Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sung Hoon Choi
- Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Tan To Cheung
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Adrian K H Chiow
- Department of Surgery, Hepatopancreatobiliary Unit, Changi General Hospital, Singapore, Singapore
| | - Iswanto Sucandy
- AdventHealth Tampa, Digestive Health Institute, Tampa, FL, USA
| | - Marco V Marino
- General Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
- Oncologic Surgery Department, P. Giaccone University Hospital, Palermo, Italy
| | - Mikel Prieto
- Hepatobiliary Surgery and Liver Transplantation Unit, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
| | - Charing C Chong
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, People's Republic of China
| | - Gi Hong Choi
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Mikhail Efanov
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert P Sutcliffe
- Department of Hepatopancreatobiliary and Liver Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Roberto I Troisi
- Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, Federico II University Hospital Naples, Naples, Federico, Italy
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Xiaoying Wang
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Mathieu D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Chung Ngai Tang
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, People's Republic of China
| | - Kohei Mishima
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan
| | - Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan
| | - Daniel Cherqui
- Department of Hepatobiliary Surgery, Assistance Publique Hopitaux de Paris, Paul-Brousse Hospital, Centre Hepato-Biliaire, Villejuif, France
| | - Davit L Aghayan
- The Intervention Centre and Department of Hepatic, Pancreatic and Biliary Surgery, Oslo University Hospital and Institute of Clinical Medicine, Oslo University, Oslo, Norway
| | - Bjorn Edwin
- The Intervention Centre and Department of Hepatic, Pancreatic and Biliary Surgery, Oslo University Hospital and Institute of Clinical Medicine, Oslo University, Oslo, Norway
| | - Olivier Scatton
- Department of Digestive, HBP and Liver Transplantation, Hopital Pitie-Salpetriere, APHP, Sorbonne Université, Paris, France
| | - Atsushi Sugioka
- Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan
| | - Tran Cong Duy Long
- Department of Hepatopancreatobiliary Surgery, University Medical Center, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Constantino Fondevila
- General and Digestive Surgery, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
- General and Digestive Surgery, Hospital Universitario La Paz, IdiPAZ, CIBERehd, Madrid, Spain
| | - Mohammad Alzoubi
- Department of Surgery, University Hospital Southampton, Southampton, UK
| | - Mohammad Abu Hilal
- Department of Surgery, University Hospital Southampton, Southampton, UK
- Department of Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - Andrea Ruzzenente
- General and Hepatobiliary Surgery, Department of Surgery, Dentistry, Gynecology and Pediatrics, University of Verona, GB Rossi Hospital, Verona, Italy
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, Mauriziano Hospital, Turin, Italy
| | - Paulo Herman
- Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Boram Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - David Fuks
- Department of Digestive, Oncologic and Metabolic Surgery, Institute Mutualiste Montsouris, Universite Paris Descartes, Paris, France
| | - Federica Cipriani
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - Qu Liu
- Faculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, People's Republic of China
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - Rong Liu
- Faculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, People's Republic of China
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, National Cancer Centre Singapore and Duke-National University Singapore Medical School, Academia, Level 5, 20 College Road, Singapore, 169856, Singapore.
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Knitter S, Feldbrügge L, Nevermann N, Globke B, Galindo SAO, Winklmann T, Krenzien F, Haber PK, Malinka T, Lurje G, Schöning W, Pratschke J, Schmelzle M. Robotic versus laparoscopic versus open major hepatectomy - an analysis of costs and postoperative outcomes in a single-center setting. Langenbecks Arch Surg 2023; 408:214. [PMID: 37247050 PMCID: PMC10226911 DOI: 10.1007/s00423-023-02953-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 05/22/2023] [Indexed: 05/30/2023]
Abstract
PURPOSE In the era of minimal-invasive surgery, the introduction of robotic liver surgery (RS) was accompanied by concerns about the increased financial expenses of the robotic technique in comparison to the established laparoscopic (LS) and conventional open surgery (OS). Therefore, we aimed to evaluate the cost-effectiveness of RS, LS and OS for major hepatectomies in this study. METHODS We analyzed financial and clinical data on patients who underwent major liver resection for benign and malign lesions from 2017 to 2019 at our department. Patients were grouped according to the technical approach in RS, LS, and OS. For better comparability, only cases stratified to the Diagnosis Related Groups (DRG) H01A and H01B were included in this study. Financial expenses were compared between RS, LS, and OS. A binary logistic regression model was used to identify parameters associated with increased costs. RESULTS RS, LS and OS accounted for median daily costs of 1,725 €, 1,633 € and 1,205 €, respectively (p < 0.0001). Median daily (p = 0.420) and total costs (16,648 € vs. 14,578 €, p = 0.076) were comparable between RS and LS. Increased financial expenses for RS were mainly caused by intraoperative costs (7,592 €, p < 0.0001). Length of procedure (hazard ratio [HR] = 5.4, 95% confidence interval [CI] = 1.7-16.9, p = 0.004), length of stay (HR [95% CI] = 8.8 [1.9-41.6], p = 0.006) and development of major complications (HR [95% CI] = 2.9 [1.7-5.1], p < 0.0001) were independently associated with higher costs. CONCLUSIONS From an economic perspective, RS may be considered a valid alternative to LS for major liver resections.
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Affiliation(s)
- Sebastian Knitter
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Linda Feldbrügge
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Nora Nevermann
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Brigitta Globke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Santiago Andres Ortiz Galindo
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Thomas Winklmann
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Felix Krenzien
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Philipp K Haber
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Thomas Malinka
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Georg Lurje
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Wenzel Schöning
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Moritz Schmelzle
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
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Jacoby H, Sucandy I, Ross S, Crespo K, Syblis C, App S, Rosemurgy A. Does metabolic syndrome affect perioperative outcomes in patients undergoing robotic hepatectomy? A propensity score-matched analysis. Surg Endosc 2023:10.1007/s00464-023-10047-4. [PMID: 37038021 DOI: 10.1007/s00464-023-10047-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 03/26/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Metabolic syndrome is a known risk factor for postoperative complications after general surgical procedures. Literature analyzing perioperative outcomes of patients with metabolic syndrome undergoing a minimally invasive hepatectomy is limited. We sought to investigate if metabolic syndrome significantly impacts the perioperative course and outcomes of patients undergoing robotic hepatectomy. METHODS With IRB, we prospectively followed patients who underwent robotic hepatectomy from 2016 through 2020. A 1:1 propensity score-matched (PSM) analysis was applied to patients with and without metabolic syndrome. Demographic and clinical data were analyzed for those cohorts before and after PSM. Metabolic syndrome was defined as BMI ≥ 28.8 kg/m2, diabetes, and hypertension. RESULTS A total of 272 patients underwent robotic hepatectomy, 39 (14%) of whom had metabolic syndrome. After performing PSM, we ended up with 74 patients, 37 in each cohort, 28% of them had liver cirrhosis. Patients with metabolic syndrome had higher BMI (34 ± 5.6 vs. 28 ± 5.9 kg/m2, p < 0.001) and MELD scores (10 ± 4.5 vs. 8 ± 3.2, p < 0.001) compared to patients without metabolic syndrome. Additionally, patients with metabolic syndrome had an increased incidence of liver cirrhosis (33% vs. 9%, p = 0.0002). Following PSM, BMI (34 ± 5.7 vs. 26 ± 4.4 kg/m2, p < 0.001) was the only preoperative variables associated with metabolic syndrome. There were no statistical differences before and after PSM between patients with and without metabolic syndrome in terms of intraoperative metrics including operative time, blood loss, conversion to 'open,' and intraoperative complications. All postoperative outcomes metrics before and after PSM did not correlate with the presence or absence of metabolic syndrome. CONCLUSIONS Metabolic syndrome had no impact on intra- or postoperative metrics, complications, or outcomes after robotic hepatectomy. We believe that the robotic approach may mitigate the adverse effects of metabolic syndrome for patients undergoing robotic hepatectomy.
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Affiliation(s)
| | - Iswanto Sucandy
- Digestive Health Institute, Tampa, FL, USA.
- Digestive Health Institute, 3000 Medical Park Drive, Suite 500, Tampa, FL, 33613, USA.
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15
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Papadopoulou K, Dorovinis P, Kykalos S, Schizas D, Stamopoulos P, Tsourouflis G, Dimitroulis D, Nikiteas N. Short-Term Outcomes After Robotic Versus Open Liver Resection: A Systematic Review and Meta-analysis. J Gastrointest Cancer 2023; 54:237-246. [PMID: 35199298 DOI: 10.1007/s12029-022-00810-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Robotic liver surgery is a novel technique expanding the field of minimally invasive approaches. An increasing number of studies assess the outcomes of robotic liver resections (RLR). The aim of our meta-analysis is to provide an up-to-date comparison of RLR versus open liver resections (OLR), evaluating its safety and efficacy. MATERIALS AND METHODS A systematic search of MEDLINE, Scopus, Google Scholar, Cochrane, and Clinicaltrials.gov for articles published from January 2000 until January 2022 was undertaken. RESULTS Thirteen non-randomized retrospective and one prospective clinical study enlisting 1801 patients met our inclusion criteria, with 640 patients undergoing RLR and 1161 undergoing OLR. RLR resulted in significantly lower overall morbidity (p < 0.001), shorter length of hospital stay (p = 0.002), and less intraoperative blood loss (p < 0.001). Operative time was found to be significantly higher in the RLR group (p < 0.001). Blood transfusion requirements, R0 resection, and mortality rates presented no difference among the two groups. The cumulative rate of conversion was 5% in the RLR group. CONCLUSION The increasing experience in the implementation of the robot will undoubtedly generate more prospective randomized studies, necessary to assess its potential superiority over the traditional open approach, in a variety of hepatic lesions.
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Affiliation(s)
- Konstantina Papadopoulou
- Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Dorovinis
- Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
- 2nd Department of Propaedeutic Surgery, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17, 11527, Athens, Greece.
| | - Stylianos Kykalos
- Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- 2nd Department of Propaedeutic Surgery, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17, 11527, Athens, Greece
| | - Dimitrios Schizas
- Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- 1st Department of Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Paraskevas Stamopoulos
- 2nd Department of Propaedeutic Surgery, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17, 11527, Athens, Greece
| | - Gerasimos Tsourouflis
- Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- 2nd Department of Propaedeutic Surgery, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17, 11527, Athens, Greece
| | - Dimitrios Dimitroulis
- Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- 2nd Department of Propaedeutic Surgery, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17, 11527, Athens, Greece
| | - Nikolaos Nikiteas
- Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- 2nd Department of Propaedeutic Surgery, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17, 11527, Athens, Greece
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16
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Outcomes and Patient Selection in Laparoscopic vs. Open Liver Resection for HCC and Colorectal Cancer Liver Metastasis. Cancers (Basel) 2023; 15:cancers15041179. [PMID: 36831521 PMCID: PMC9954110 DOI: 10.3390/cancers15041179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
Hepatocellular carcinoma (HCC) and colorectal liver metastasis (CRLM) are the two most common malignant tumors that require liver resection. While liver transplantation is the best treatment for HCC, organ shortages and high costs limit the availability of this option for many patients and make resection the mainstay of treatment. For patients with CRLM, surgical resection with negative margins is the only potentially curative option. Over the last two decades, laparoscopic liver resection (LLR) has been increasingly adopted for the resection of a variety of tumors and was found to have similar long-term outcomes compared to open liver resection (OLR) while offering the benefits of improved short-term outcomes. In this review, we discuss the current literature on the outcomes of LLR vs. OLR for patients with HCC and CRLM. Although the use of LLR for HCC and CRLM is increasing, it is not appropriate for all patients. We describe an approach to selecting patients best-suited for LLR. The four common difficulty-scoring systems for LLR are summarized. Additionally, we review the current evidence behind the emerging robotically assisted liver resection technology.
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Vining CC, Al Abbas AI, Kuchta K, Paterakos P, Choi SH, Talamonti M, Hogg ME. Risk factors and outcomes in patients undergoing minimally invasive hepatectomy with unplanned conversion: a contemporary NSQIP analysis. HPB (Oxford) 2023; 25:577-588. [PMID: 36868951 DOI: 10.1016/j.hpb.2023.01.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 11/19/2022] [Accepted: 01/30/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Minimally invasive techniques are growing for hepatectomies. Laparoscopic and robotic liver resections have been shown to differ in conversions. We hypothesize that robotic approach will have decreased conversion to open and complications despite being a newer technique than laparoscopy. METHODS ACS NSQIP study using the targeted Liver PUF from 2014 to 2020. Patients grouped based on hepatectomy type and approach. Multivariable and propensity scored matching (PSM) was used to analyze the groups. RESULTS Of 7767 patients who underwent hepatectomy, 6834 were laparoscopic and 933 were robotic. The rate of conversions was significantly lower in robotic vs laparoscopic (7.8% vs 14.7%; p < 0.001). Robotic hepatectomy was associated with decreased conversion for minor (6.2% vs 13.1%; p < 0.001), but not major, right, or left hepatectomy. Operative factors associated with conversion included Pringle (OR = 2.09 [95% CI 1.05-4.19]; p = 0.0369), and a laparoscopic approach (OR = 1.96 [95% CI 1.53-2.52]; p < 0.001). Undergoing conversion was associated with increases in bile leak (13.7% vs 4.9%; p < 0.001), readmission (11.5% vs 6.1%; p < 0.001), mortality (2.1% vs 0.6%; p < 0.001), length of stay (5 days vs 3 days; p < 0.001), and surgical (30.5% vs 10.1%; p < 0.001), wound (4.9% vs 1.5%; p < 0.001) and medical (17.5% vs 6.7%; p < 0.001) complications. CONCLUSION Minimally invasive hepatectomy with conversion is associated with increased complications, and conversion is increased in the laparoscopic compared to a robotic approach.
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Affiliation(s)
| | - Amr I Al Abbas
- University of Texas Southwestern, Department of Surgery, United States
| | - Kristine Kuchta
- NorthShore University HealthSystem, Department of Surgery, United States
| | - Pierce Paterakos
- NorthShore University HealthSystem, Department of Surgery, United States
| | - Sung H Choi
- NorthShore University HealthSystem, Department of Surgery, United States
| | - Mark Talamonti
- NorthShore University HealthSystem, Department of Surgery, United States; University of Chicago, Department of Surgery, United States
| | - Melissa E Hogg
- NorthShore University HealthSystem, Department of Surgery, United States; University of Chicago, Department of Surgery, United States.
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D'Hondt M, Devooght A, Willems E, Wicherts D, De Meyere C, Parmentier I, Provoost A, Pottel H, Verslype C. Transition from laparoscopic to robotic liver surgery: clinical outcomes, learning curve effect, and cost-effectiveness. J Robot Surg 2023; 17:79-88. [PMID: 35322342 DOI: 10.1007/s11701-022-01405-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/16/2022] [Indexed: 12/30/2022]
Abstract
The reproducibility of the implementation of robotic liver surgery (RLS) is still debated. The aim of the present study is to evaluate short-term outcomes and cost differences during the implementation of RLS, performed by an early adopter in laparoscopic liver surgery (LLS). Patients undergoing RLS between February 2020 and May 2021 were included. Short-term outcomes of the robotic group (RG) were compared to the "Initial Phase" group (IP) of 120 LLS cases and the 120 most recent laparoscopic cases or "Mastery Phase" group (MP). A cost analysis per procedure for the three groups was performed. Seventy-one patients underwent RLS during the study period. Median operative time in the RG was comparable to the IP, but significantly shorter in the MP (140 vs 138 vs 120 min, p < 0.001). Median intraoperative blood loss in the RG was lower than in both laparoscopic groups (40 ml [20-90 ml] vs 150 ml [50-250 ml] vs 80 ml [30-150 ml], p < 0.001). Median hospital stay in the RG was significantly shorter than the IP group (p < 0.001). There were no significant differences in postoperative complication, conversion, or readmission rates. Procedural cost analysis was in favor of robotic surgery (€5008) compared to the IP (€ 6913) and the MP (€6099). Surgeons with sufficient experience in LLS can rapidly overcome the learning curve for RLS. In our experience, the short-term outcomes of the implementation phase of RLS are similar to the mastery phase of LLS. The total average cost per procedure is lower for RLS compared to LLS.
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Affiliation(s)
- M D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium.
| | - A Devooght
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium
| | - E Willems
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium
| | - D Wicherts
- Department of Abdominal Surgery, Hospital Oost-Limburg, Genk, Belgium
| | - C De Meyere
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium
| | - I Parmentier
- Department of Oncology and Statistics, Groeninge Hospital, Kortrijk, Belgium
| | - A Provoost
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium
| | - H Pottel
- Interdisciplinary Research Centre, Leuven University Campus Kortrijk, Kortrijk, Belgium
| | - C Verslype
- Department of Gastroenterology and Hepatology, KU Leuven, Leuven, Belgium
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Ahmad A, Freeman HD, Corn SD. Robotic major and minor hepatectomy: critical appraisal of learning curve and its impact on outcomes. Surg Endosc 2022; 37:2915-2922. [PMID: 36509949 DOI: 10.1007/s00464-022-09809-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Robotic hepatectomy has gained increasing acceptance across the US. Although the robotic approach offers significant technical advantages, it is still bound by the individual surgeon's learning curve. Proficiency in this approach should theoretically lead to improved peri-operative outcomes. METHODS Between 2017 and 2020, data on 148 consecutive robotic hepatectomies performed by a single surgeon was retrospectively analyzed. Using cumulative sum (CUSUM) method, intraoperative blood loss (EBL) and operative time were used to assess learning curves for robotic major (n = 58) and minor (n = 90) hepatectomy patients. Perioperative outcomes were compared in regards with proficiency. RESULTS Proficiency for robotic major and minor hepatectomy was achieved after 22 cases and 34 cases, respectively. No significant differences were observed in patient demographics or tumor characteristics. For robotic major hepatectomy, when compared to early experience, proficiency was associated with a significant improvement in mean EBL (242 mL vs 118 mL, p = 0.0004), operative time (330 min vs 247 min, p = 0.0002), decreased overall complication rate (23% vs 3%, p = 0.039), and length of hospital stay (5.7 days vs 4.1 days, p = 0.004). No difference in conversion rate, mortality or 30 day readmission was seen. For robotic minor hepatectomy, proficiency was associated with significantly decreased mean EBL (115 mL vs 54 mL, p = 0.005), operative time (168 vs 125 min, p = 0.014), and length of hospital stay (2.8 days vs 2.1 days, p = 0.021). No difference was observed in conversion rate, overall complications, mortality or 30 day readmission. CONCLUSION In the modern era, robotic hepatectomy offers a safe approach with excellent perioperative outcomes. Post learning curve proficiency is associated with significant improvements in perioperative outcomes in both major and minor hepatectomy. Results from our study can serve as a guide to surgeons and programs looking to adopt this technique.
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Affiliation(s)
- Ali Ahmad
- Department of Surgical Oncology, School of Medicine-Wichita, University of Kansas, 818 N Emporia Ave, Wichita, KS, 67214, USA.
| | - Hadley D Freeman
- Department of Surgical Oncology, School of Medicine-Wichita, University of Kansas, 818 N Emporia Ave, Wichita, KS, 67214, USA
| | - Sarah D Corn
- Department of Surgical Oncology, School of Medicine-Wichita, University of Kansas, 818 N Emporia Ave, Wichita, KS, 67214, USA
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Laparoscopic versus Robotic Hepatectomy: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11195831. [PMID: 36233697 PMCID: PMC9571364 DOI: 10.3390/jcm11195831] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/28/2022] [Accepted: 09/24/2022] [Indexed: 12/02/2022] Open
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.
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Bozkurt E, Sijberden JP, Hilal MA. What Is the Current Role and What Are the Prospects of the Robotic Approach in Liver Surgery? Cancers (Basel) 2022; 14:4268. [PMID: 36077803 PMCID: PMC9454668 DOI: 10.3390/cancers14174268] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 12/15/2022] Open
Abstract
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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Affiliation(s)
- Emre Bozkurt
- Department of Surgery, Poliambulanza Foundation Hospital, 25124 Brescia, Italy
- Department of Surgery, Hepatopancreatobiliary Surgery Division, Koç University Hospital, Istanbul 34010, Turkey
| | - Jasper P. Sijberden
- Department of Surgery, Poliambulanza Foundation Hospital, 25124 Brescia, Italy
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Mohammed Abu Hilal
- Department of Surgery, Poliambulanza Foundation Hospital, 25124 Brescia, Italy
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
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22
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Rahimli M, Perrakis A, Andric M, Stockheim J, Franz M, Arend J, Al-Madhi S, Abu Hilal M, Gumbs AA, Croner RS. Does Robotic Liver Surgery Enhance R0 Results in Liver Malignancies during Minimally Invasive Liver Surgery?-A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:3360. [PMID: 35884421 PMCID: PMC9320889 DOI: 10.3390/cancers14143360] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Robotic procedures are an integral part of modern liver surgery. However, the advantages of a robotic approach in comparison to the conventional laparoscopic approach are the subject of controversial debate. The aim of this systematic review and meta-analysis is to compare robotic and laparoscopic liver resection with particular attention to the resection margin status in malignant cases. METHODS A systematic literature search was performed using PubMed and Cochrane Library in accordance with the PRISMA guidelines. Only studies comparing robotic and laparoscopic liver resections were considered for this meta-analysis. Furthermore, the rate of the positive resection margin or R0 rate in malignant cases had to be clearly identifiable. We used fixed or random effects models according to heterogeneity. RESULTS Fourteen studies with a total number of 1530 cases were included in qualitative and quantitative synthesis. Malignancies were identified in 71.1% (n = 1088) of these cases. These included hepatocellular carcinoma, cholangiocarcinoma, colorectal liver metastases and other malignancies of the liver. Positive resection margins were noted in 24 cases (5.3%) in the robotic group and in 54 cases (8.6%) in the laparoscopic group (OR = 0.71; 95% CI (0.42-1.18); p = 0.18). Tumor size was significantly larger in the robotic group (MD = 6.92; 95% CI (2.93-10.91); p = 0.0007). The operation time was significantly longer in the robotic procedure (MD = 28.12; 95% CI (3.66-52.57); p = 0.02). There were no significant differences between the robotic and laparoscopic approaches regarding the intra-operative blood loss, length of hospital stay, overall and severe complications and conversion rate. CONCLUSION Our meta-analysis showed no significant difference between the robotic and laparoscopic procedures regarding the resection margin status. Tumor size was significantly larger in the robotic group. However, randomized controlled trials with long-term follow-up are needed to demonstrate the benefits of robotics in liver surgery.
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Affiliation(s)
- Mirhasan Rahimli
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany; (A.P.); (M.A.); (J.S.); (M.F.); (J.A.); (S.A.-M.); (R.S.C.)
| | - Aristotelis Perrakis
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany; (A.P.); (M.A.); (J.S.); (M.F.); (J.A.); (S.A.-M.); (R.S.C.)
| | - Mihailo Andric
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany; (A.P.); (M.A.); (J.S.); (M.F.); (J.A.); (S.A.-M.); (R.S.C.)
| | - Jessica Stockheim
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany; (A.P.); (M.A.); (J.S.); (M.F.); (J.A.); (S.A.-M.); (R.S.C.)
| | - Mareike Franz
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany; (A.P.); (M.A.); (J.S.); (M.F.); (J.A.); (S.A.-M.); (R.S.C.)
| | - Joerg Arend
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany; (A.P.); (M.A.); (J.S.); (M.F.); (J.A.); (S.A.-M.); (R.S.C.)
| | - Sara Al-Madhi
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany; (A.P.); (M.A.); (J.S.); (M.F.); (J.A.); (S.A.-M.); (R.S.C.)
| | - Mohammed Abu Hilal
- Unità Chirurgia Epatobiliopancreatica, Robotica e Mininvasiva, Fondazione Poliambulanza Istituto Ospedaliero, Via Bissolati, 57, 25124 Brescia, Italy;
| | - Andrew A. Gumbs
- Department of Surgery, Centre Hospitalier Intercommunal de Poissy/Saint-Germain-en-Laye, 10 Rue du Champ Gaillard, 78300 Poissy, France;
| | - Roland S. Croner
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany; (A.P.); (M.A.); (J.S.); (M.F.); (J.A.); (S.A.-M.); (R.S.C.)
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Chong CC, Fuks D, Lee KF, Zhao JJ, Choi GH, Sucandy I, Chiow AKH, Marino MV, Gastaca M, Wang X, Lee JH, Efanov M, Kingham TP, D’Hondt M, Troisi RI, Choi SH, Sutcliffe RP, Chan CY, Lai ECH, Park JO, Di Benedetto F, Rotellar F, Sugioka A, Coelho FF, Ferrero A, Long TCD, Lim C, Scatton O, Liu Q, Schmelzle M, Pratschke J, Cheung TT, Liu R, Han HS, Tang CN, Goh BKP. Propensity Score-Matched Analysis Comparing Robotic and Laparoscopic Right and Extended Right Hepatectomy. JAMA Surg 2022; 157:436-444. [PMID: 35262660 PMCID: PMC8908223 DOI: 10.1001/jamasurg.2022.0161] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/29/2021] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Laparoscopic and robotic techniques have both been well adopted as safe options in selected patients undergoing hepatectomy. However, it is unknown whether either approach is superior, especially for major hepatectomy such as right hepatectomy or extended right hepatectomy (RH/ERH). OBJECTIVE To compare the outcomes of robotic vs laparoscopic RH/ERH. DESIGN, SETTING, AND PARTICIPANTS In this case-control study, propensity score matching analysis was performed to minimize selection bias. Patients undergoing robotic or laparoscopic RH/EHR at 29 international centers from 2008 to 2020 were included. INTERVENTIONS Robotic vs laparoscopic RH/ERH. MAIN OUTCOMES AND MEASURES Data on patient demographics, tumor characteristics, and short-term perioperative outcomes were collected and analyzed. RESULTS Of 989 individuals who met study criteria, 220 underwent robotic and 769 underwent laparoscopic surgery. The median (IQR) age in the robotic RH/ERH group was 61.00 (51.86-69.00) years and in the laparoscopic RH/ERH group was 62.00 (52.03-70.00) years. Propensity score matching resulted in 220 matched pairs for further analysis. Patients' demographics and tumor characteristics were comparable in the matched cohorts. Robotic RH/ERH was associated with a lower open conversion rate (19 of 220 [8.6%] vs 39 of 220 [17.1%]; P = .01) and a shorter postoperative hospital stay (median [IQR], 7.0 [5.0-10.0] days; mean [SD], 9.11 [7.52] days vs median [IQR], 7.0 [5.75-10.0] days; mean [SD], 9.94 [8.99] days; P = .048). On subset analysis of cases performed between 2015 and 2020 after a center's learning curve (50 cases), robotic RH/ERH was associated with a shorter postoperative hospital stay (median [IQR], 6.0 [5.0-9.0] days vs 7.0 [6.0-9.75] days; P = .04) with a similar conversion rate (12 of 220 [7.6%] vs 17 of 220 [10.8%]; P = .46). CONCLUSION AND RELEVANCE Robotic RH/ERH was associated with a lower open conversion rate and shorter postoperative hospital stay compared with laparoscopic RH/ERH. The difference in open conversion rate was associated with a significant decrease for laparoscopic but not robotic RH/ERH after a center had mounted the learning curve. Use of robotic platform may help to overcome the initial challenges of minimally invasive RH/ERH.
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Affiliation(s)
- Charing C. Chong
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - David Fuks
- Department of Digestive, Oncologic and Metabolic Surgery, Institute Mutualiste Montsouris, Universite Paris Descartes, Paris, France
| | - Kit-Fai Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Joseph J. Zhao
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gi Hong Choi
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Iswanto Sucandy
- AdventHealth Tampa, Digestive Health Institute, Tampa, Florida
| | - Adrian K. H. Chiow
- Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital, Singapore
| | - Marco V. Marino
- General Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy and Oncologic Surgery Department, P. Giaccone University Hospital, Palermo, Italy
| | - Mikel Gastaca
- Hepatobiliary Surgery and Liver Transplantation Unit, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
| | - Xiaoying Wang
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jae Hoon Lee
- Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mikhail Efanov
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia
| | - T. Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mathieu D’Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Roberto I. Troisi
- Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, Federico II University Hospital Naples, Naples, Italy
| | - Sung-Hoon Choi
- Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Robert P. Sutcliffe
- Department of Hepatopancreatobiliary and Liver Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Chung-Yip Chan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and Duke-National University Singapore Medical School, Singapore
| | - Eric C. H. Lai
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - James O. Park
- Hepatobiliary Surgical Oncology, Department of Surgery, University of Washington Medical Center, Seattle
| | - Fabrizio Di Benedetto
- Hepatopancreatobiliary Surgery and Liver Transplant Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Fernando Rotellar
- HPB and Liver Transplant, Department of General Surgery, Clinica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain
- Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
| | - Atsushi Sugioka
- Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan
| | - Fabricio Ferreira Coelho
- Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Alessandro Ferrero
- Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Turin, Italy
| | - Tran Cong Duy Long
- HPB Surgery Department, University Medical Center, HCMC, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Chetana Lim
- Department of Digestive, HBP and Liver Transplantation, Hopital Pitie-Salpetriere, APHP, Sorbonne Université, Paris, France
| | - Olivier Scatton
- Department of Digestive, HBP and Liver Transplantation, Hopital Pitie-Salpetriere, APHP, Sorbonne Université, Paris, France
| | - Qu Liu
- Faculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Moritz Schmelzle
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Tan-To Cheung
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Rong Liu
- Faculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chung Ngai Tang
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - Brian K. P. Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and Duke-National University Singapore Medical School, Singapore
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Ciria R, Berardi G, Alconchel F, Briceño J, Choi GH, Wu YM, Sugioka A, Troisi RI, Salloum C, Soubrane O, Pratschke J, Martinie J, Tsung A, Araujo R, Sucandy I, Tang CN, Wakabayashi G. The impact of robotics in liver surgery: A worldwide systematic review and short-term outcomes meta-analysis on 2,728 cases. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022; 29:181-197. [PMID: 33200536 DOI: 10.1002/jhbp.869] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 10/22/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The dissemination of robotic liver surgery is slow-paced and must face the obstacle of demonstrating advantages over open and laparoscopic (LLS) approaches. Our objective was to show the current position of robotic liver surgery (RLS) worldwide and to identify if improved short-term outcomes are observed, including secondary meta-analyses for type of resection, etiology, and cost analysis. METHODS A PRISMA-based systematic review was performed to identify manuscripts comparing RLS vs open or LLS approaches. Quality analysis was performed using the Newcatle-Ottawa score. Statistical analysis was performed after heterogeneity test and fixed- or random-effect models were chosen accordingly. RESULTS After removing duplications, 2728 RLS cases were identified from the final set of 150 manuscripts. More than 75% of the cases have been performed on malignancies. Meta-analysis from the 38 comparative reports showed that RLS may offer improved short-term outcomes compared to open procedures in most of the variables screened. Compared to LLS, some advantages may be observed in favour of RLS for major resections in terms of operative time, hospital stay and rate of complications. Cost analyses showed an increased cost per procedure of around US$5000. CONCLUSIONS The advantages of RLS still need to be demonstrated although early results are promising. Advantages vs open approach are demonstrated. Compared to laparoscopic surgery, minor perioperative advantages may be observed for major resections although cost analyses are still unfavorable to the robotic approach.
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Affiliation(s)
- Ruben Ciria
- Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, Córdoba, Spain
| | - Giammauro Berardi
- Center for Advanced Treatment of HBP Diseases, Ageo Central General Hospital, Saitama, Japan
- Department of Human Structure and Repair of Man, Ghent University, Ghent, Belgium
| | - Felipe Alconchel
- Unit of Hepatobiliary Surgery and Liver Transplantation, Virgen de la Arrixaca University Hospital (IMIB-Arrixaca), Murcia, Spain
| | - Javier Briceño
- Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, Córdoba, Spain
| | - Gi Hong Choi
- Division of Hepatopancreaticobiliary Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Yao-Ming Wu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Atsushi Sugioka
- Department of Surgery, Fujita Health University, Toyoake, Japan
| | - Roberto Ivan Troisi
- Department of Human Structure and Repair of Man, Ghent University, Ghent, Belgium
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
- Department of HPB Surgery and Liver Transplantation, King Faisal Hospital and Research Center, Al Faisal University, Riyadh, Saudi Arabia
| | - Chady Salloum
- Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est, Créteil, France
- Centre Hépato-Biliaire, Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris, Université Paris-Sud, Villejuif, France
| | - Olivier Soubrane
- Department of Hepatobiliary and Liver Transplantation Surgery, Hôpital Beaujon, Paris, France
| | - Johann Pratschke
- Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - John Martinie
- Division of HPB Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Allan Tsung
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Raphael Araujo
- Barretos Cancer Hospital, São Paulo, Brazil
- Escola Paulista de Medicina-UNIFESP, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Iswanto Sucandy
- Digestive Disease Institute, Florida Hospital Tampa, Tampa, FL, USA
| | - Chung N Tang
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - Go Wakabayashi
- Center for Advanced Treatment of HBP Diseases, Ageo Central General Hospital, Saitama, Japan
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Durán M, Briceño J, Padial A, Anelli FM, Sánchez-Hidalgo JM, Ayllón MD, Calleja-Lozano R, García-Gaitan C. Short-term outcomes of robotic liver resection: An initial single-institution experience. World J Hepatol 2022; 14:224-233. [PMID: 35126850 PMCID: PMC8790404 DOI: 10.4254/wjh.v14.i1.224] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 12/02/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Liver surgery has traditionally been characterized by the complexity of its procedures and potentially high rates of morbidity and mortality in inexperienced hands. The robotic approach has gradually been introduced in liver surgery and has increased notably in recent years. However, few centers currently perform robotic liver surgery and experiences in robot-assisted surgical procedures continue to be limited compared to the laparoscopic approach.
AIM To analyze the outcomes and feasibility of an initial robotic liver program implemented in an experienced laparoscopic hepatobiliary center.
METHODS A total of forty consecutive patients underwent robotic liver resection (da Vinci Xi, intuitive.com, United States) between June 2019 and January 2021. Patients were prospectively followed and retrospectively reviewed. Clinicopathological characteristics and perioperative and short-term outcomes were analyzed. Data are expressed as mean and standard deviation. The study was approved by the Institutional Review Board.
RESULTS The mean age of patients was 59.55 years, of which 18 (45%) were female. The mean body mass index was 29.41 kg/m². Nine patients (22.5%) were cirrhotic. Patients were divided by type of resection as follows: Ten segmentectomies, three wedge resections, ten left lateral sectionectomies, six bisegmentectomies (two V-VI bisegmentectomies and four IVb-V bisegmentectomies), two right anterior sectionectomies, five left hepatectomies and two right hepatectomies. Malignant lesions occurred in twenty-nine (72.5%) of the patients. The mean operative time was 258.11 min and two patients were transfused intraoperatively (5%). Inflow occlusion was used in thirty cases (75%) and the mean total clamping time was 32.62 min. There was a single conversion due to uncontrollable hemorrhage. Major postoperative complications (Clavien–Dindo > IIIb) occurred in three patients (7.5%) and mortality in one (2.5%). No patient required readmission to the hospital. The mean hospital stay was 5.6 d.
CONCLUSION Although robotic hepatectomy is a safe and feasible procedure with favorable short-term outcomes, it involves a demanding learning curve that requires a high level of training, skill and dexterity.
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Affiliation(s)
- Manuel Durán
- Unit of Hepatobiliary Surgery and Liver Transplantation, General and Digestive Surgery Department, Reina Sofia University Hospital, Cordoba 14004, Spain
- GC18 Translational Research in Surgery of Solid Organ Transplantation, Maimonides Biomedical Research Institute, Córdoba 14004, Spain
| | - Javier Briceño
- Unit of Hepatobiliary Surgery and Liver Transplantation, General and Digestive Surgery Department, Reina Sofia University Hospital, Cordoba 14004, Spain
- GC18 Translational Research in Surgery of Solid Organ Transplantation, Maimonides Biomedical Research Institute, Córdoba 14004, Spain
| | - Ana Padial
- Unit of Hepatobiliary Surgery and Liver Transplantation, General and Digestive Surgery Department, Reina Sofia University Hospital, Cordoba 14004, Spain
- GC18 Translational Research in Surgery of Solid Organ Transplantation, Maimonides Biomedical Research Institute, Córdoba 14004, Spain
| | - Ferdinando Massimiliano Anelli
- Unit of Hepatobiliary Surgery and Liver Transplantation, General and Digestive Surgery Department, Reina Sofia University Hospital, Cordoba 14004, Spain
- GC18 Translational Research in Surgery of Solid Organ Transplantation, Maimonides Biomedical Research Institute, Córdoba 14004, Spain
| | - Juan Manuel Sánchez-Hidalgo
- Unit of Hepatobiliary Surgery and Liver Transplantation, General and Digestive Surgery Department, Reina Sofia University Hospital, Cordoba 14004, Spain
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical Research Institute, Córdoba 14004, Spain
| | - María Dolores Ayllón
- Unit of Hepatobiliary Surgery and Liver Transplantation, General and Digestive Surgery Department, Reina Sofia University Hospital, Cordoba 14004, Spain
- GC18 Translational Research in Surgery of Solid Organ Transplantation, Maimonides Biomedical Research Institute, Córdoba 14004, Spain
| | - Rafael Calleja-Lozano
- Unit of Hepatobiliary Surgery and Liver Transplantation, General and Digestive Surgery Department, Reina Sofia University Hospital, Cordoba 14004, Spain
- GC18 Translational Research in Surgery of Solid Organ Transplantation, Maimonides Biomedical Research Institute, Córdoba 14004, Spain
| | - Carmen García-Gaitan
- Department of Anesthesiology and Resuscitation, Reina Sofia University Hospital, Cordoba 14004, Spain
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Sucandy I, Jacoby H, Crespo K, Syblis C, App S, Ignatius J, Ross S, Rosemurgy A. A Single Institution's Experience With Robotic Minor and Major Hepatectomy. Am Surg 2021:31348211047500. [PMID: 34798777 DOI: 10.1177/00031348211047500] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Minimally invasive liver resection is gradually becoming the preferred technique to treat liver tumors due its salutary benefits when compared with traditional "open" method. While robotic technology improves surgeon dexterity to better perform complex operations, outcomes of robotic hepatectomy have not been adequately studied. We therefore describe our institutional experience with robotic minor and major hepatectomy. MATERIALS AND METHODS We prospectively study all patients undergoing robotic hepatectomy from 2016 to 2020. RESULTS A total of 220 patients underwent robotic hepatectomy. 138 (63%) were major hepatectomies while 82 (37%) were minor hepatectomies. Median age was 63 (62 ± 13) years, 118 (54%) were female. 168 patients had neoplastic disease and 52 patients had benign disease. Lesion size in patients who had undergone minor hepatectomy was 2 (3 ± 2.5) cm, compared to 5 (5 ± 3.0) cm in patients who undergone major hepatectomy (P < .001). 97% of patients underwent R0 resections while none of the patients had R2 resection. Operative duration was 226 (260 ± 122.7) vs 282 (299 ± 118.7) minutes (P ≤ .05); estimated blood loss was 100 (163 ± 259.2) vs 200 (251 ± 246.7) mL (P ≤ .05) for minor and major hepatectomy, respectively. One patient had intraoperative bleeding requiring "open" conversion. Nine (4%) patients had experienced notable postoperative complications and 2 (1%) patients died postoperatively. Length of stay was 3 (5 ± 4.6) vs 4 (5 ± 2.8) days for minor vs major hepatectomy (P = .84). Reoperation and readmission rate for minor vs major hepatectomy was 1% vs 3% (P = .65) and 9% vs 10% (P = .81), respectively. DISCUSSION Robotic major hepatectomy is safe, feasible, and efficacious with excellent postoperative outcomes.
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Affiliation(s)
- Iswanto Sucandy
- Digestive Health Institute, 4422AdventHealth Tampa, Tampa, FL, USA
| | - Harel Jacoby
- Digestive Health Institute, 4422AdventHealth Tampa, Tampa, FL, USA
| | - Kaitlyn Crespo
- Digestive Health Institute, 4422AdventHealth Tampa, Tampa, FL, USA
| | - Cameron Syblis
- Digestive Health Institute, 4422AdventHealth Tampa, Tampa, FL, USA
| | - Samantha App
- Digestive Health Institute, 4422AdventHealth Tampa, Tampa, FL, USA
| | - Joshua Ignatius
- Digestive Health Institute, 4422AdventHealth Tampa, Tampa, FL, USA
| | - Sharona Ross
- Digestive Health Institute, 4422AdventHealth Tampa, Tampa, FL, USA
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Hajibandeh S, Hajibandeh S, Dosis A, Qayum MK, Hassan K, Kausar A, Satyadas T. Level 2a evidence comparing robotic versus laparoscopic left lateral hepatic sectionectomy: a meta-analysis. Langenbecks Arch Surg 2021; 407:479-489. [PMID: 34698926 DOI: 10.1007/s00423-021-02366-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To evaluate comparative outcomes of robotic and laparoscopic left lateral hepatic sectionectomy (LLS). METHODS A systematic search of PubMed, Web of Science, EMBASE and bibliographic reference lists with application of a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits was conducted. Overall, minor (Clavien-Dindo grade < III) and major (Clavien-Dindo grade > III) postoperative complications, mortality, volume of blood loss, conversion to an open procedure, procedure time, length of hospital stay, cost-effectiveness and R1 resection were the evaluated outcome measures. RESULTS Seven comparative observational studies reporting a total of 319 patients of whom 150 underwent robotic LLS and the remaining 169 patients underwent laparoscopic LLS were included. The robotic approach was associated with significantly longer procedure time (MD: 29.40 min, p = 0.01) and higher cost (MD: $4170, p < 0.00001) compared to the laparoscopic approach. There was no significant difference in overall postoperative morbidity (OR: 1.29, p = 0.62), Clavien-Dindo grade < III (OR: 1.65, p = 0.49), Clavien-Dindo grade > III (OR: 1.18, p = 0.85), perioperative mortality (RD: 0.00, p = 1.00), volume of blood loss (MD: 1.96 mls, p = 0.91), conversion to an open procedure (RD: - 0.02, p = 0.46), length of hospital stay (MD: 0.22 day, p = 0.52) or R1 resection (RD:0.00, p = 1.00) between two groups. CONCLUSIONS Meta-analysis of the best available evidence (level 2) demonstrated that robotic LLS is associated with significantly longer procedure time and higher cost and similar perioperative outcomes compared to the laparoscopic approach. Future randomised studies are required to evaluate short-term perioperative, long-term oncological and surgeon-centred outcomes.
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Affiliation(s)
- Shahin Hajibandeh
- Hepatobiliary and Pancreatic Surgery and Liver Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK.
| | - Shahab Hajibandeh
- Department of General Surgery, Royal Glamorgan Hospital, Cwm Taf University Health Board, Pontyclun, UK
| | - Alexios Dosis
- Department of General Surgery, Bradford Royal Infirmary, Bradford, Yorkshire, UK
| | - Mohammed Kaif Qayum
- Hepatobiliary and Pancreatic Surgery and Liver Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Karim Hassan
- Department of General Surgery, Royal Glamorgan Hospital, Cwm Taf University Health Board, Pontyclun, UK
| | - Ambareen Kausar
- Department of Hepato-Pancreato-Biliary Surgery, Royal Blackburn Hospital, Blackburn, UK
| | - Thomas Satyadas
- Department of Hepatobiliary and Pancreatic Surgery, Manchester Royal Infirmary Hospital, Manchester, UK
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Implementing a robotic liver resection program does not always require prior laparoscopic experience. Surg Endosc 2021; 36:3317-3322. [PMID: 34606006 PMCID: PMC9001282 DOI: 10.1007/s00464-021-08645-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 07/16/2021] [Indexed: 02/07/2023]
Abstract
Background Preliminary experience in laparoscopic liver surgery is usually suggested prior to implementation of a robotic liver resection program. Methods This was a retrospective cohort analysis of patients undergoing robotic (RLR) versus laparoscopic liver resection (LLR) for hepatocellular carcinoma at a center with concomitant initiation of robotic and laparoscopic programs Results A total of 92 consecutive patients operated on between May 2014 and February 2019 were included: 40 RLR versus 52 LLR. Median age (69 vs. 67; p = 0.74), male sex (62.5% vs. 59.6%; p = 0.96), incidence of chronic liver disease (97.5% vs.98.1%; p = 0.85), median model for end-stage liver disease (MELD) score (8 vs. 9; p = 0.92), and median largest nodule size (22 vs. 24 mm) were similar between RLR and LLR. In the LLR group, there was a numerically higher incidence of nodules located in segment 4 (20.0% vs. 16.6%; p = 0.79); a numerically higher use of Pringle’s maneuver (32.7% vs. 20%; p = 0.23), and a shorter duration of surgery (median of 165.5 vs. 217.5 min; p = 0.04). Incidence of complications (25% vs.32.7%; p = 0.49), blood transfusions (2.5% vs.9.6%; p = 0.21), and median length of stay (6 vs. 5; p = 0.54) were similar between RLR and LLR. The overall (OS) and recurrence-free (RFS) survival rates at 1 and 5 years were 100 and 79 and 95 and 26% for RLR versus 96.2 and 76.9 and 84.6 and 26.9% for LLR (log-rank p = 0.65 for OS and 0.72 for RFS). Conclusions Based on our results, concurrent implementation of a robotic and laparoscopic liver resection program appears feasible and safe, and is associated with similar oncologic long-term outcomes.
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Lee B, Choi Y, Cho JY, Yoon YS, Han HS. Initial experience with a robotic hepatectomy program at a high-volume laparoscopic center: single-center experience and surgical tips. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1132. [PMID: 34430573 PMCID: PMC8350693 DOI: 10.21037/atm-21-202] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/23/2021] [Indexed: 01/16/2023]
Abstract
Background Despite the development of laparoscopic surgery, there are still inherent limitations associated with conventional laparoscopic instruments such as restrictions in movement and an inability for articulation. Robotic surgery may help to overcome the limitations of conventional laparoscopic surgery. The aim of this study was to present our initial experience with robotic hepatectomy (RH) and discuss the steps required to develop an RH program at a high-volume laparoscopic hepatectomy (LH) center. Methods We retrospectively reviewed prospectively collected data for 14 consecutive patients who underwent RH between 2017 and 2018. Clinicopathological characteristics and perioperative outcomes were compared with those reported in previous studies. The operation time of each procedure was analyzed to assess RH proficiency based on experience. Results Of the 14 patients, 12 patients (85.7%) underwent robotic major hepatectomy. Median patient age was 54.5 years, while median body mass index (BMI) was 25.2 kg/m2. The median operation time was 360 (range: 145–544) min. The median estimated blood loss (EBL) was 300 (range: 50–1,400) mL. Conversion to open surgery was not required in any case. The median length of hospital stay was 5 (range: 4–14) days. Major complications occurred in 2 patients (14.2%), although both recovered without sequelae. The time required for hilar dissection, docking, and parenchymal transection gradually decreased after the first two cases of RH. Conclusions From our initial experience, RH might be considered as a feasible procedure in the liver resection, even in major hepatectomy. In addition, surgeons with sufficient experience in LH could rapidly adapt for RH. However, we have to make a system for education and monitoring of this innovative surgery for the patients’ safety.
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Affiliation(s)
- Boram Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - YoungRok Choi
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
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Tsekouras K, Spartalis E, Mamakos N, Tsourouflis G, Nikiteas NI, Dimitroulis D. The Use of Robotics in Surgery of Benign Liver Diseases: A Systematic Review. Surg Innov 2021; 29:258-268. [PMID: 34275339 DOI: 10.1177/15533506211031414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Surgical treatment of benign liver diseases (BLD) remains a field of conflict, due to increased risk and high complication rate. However, the introduction of minimally invasive surgery has led to increased number of patients with BLD being treated surgically, with similar outcomes and fewer complications. Current data support the application of laparoscopic surgery (LS) and robotic surgery (RS) in surgical treatment of liver malignancies, but there are insufficient data concerning the application of robotic surgery in BLD. In the present systematic review, we aimed to evaluate the application of RS in BLD surgery. METHODS After a thorough search of Medline, Scopus, and Cochrane Library, 12 studies were considered eligible with a total number of 115 patients with BLD. DISCUSSION In brief, RS appears to be a safe and feasible option for BLD surgery. When compared to open surgery, RS is associated with lower blood loss, shorter length of stay, and fewer complication rate. Regarding LS, the peri- and postoperative outcomes were similar, but RS can overcome the technical limitations of LS. However, the cost of RS remains a major drawback in its widespread application. CONCLUSIONS Considering our findings, RS can be a safe and feasible option for BLD surgery, but further studies are needed to justify the introduction of RS in liver surgery and to define the type of patients that will benefit the most from it.
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Affiliation(s)
- Konstantinos Tsekouras
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens Medical School, 68989National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftherios Spartalis
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens Medical School, 68989National and Kapodistrian University of Athens, Athens, Greece.,Second Department of Propaedeutic Surgery, Laiko Hospital, Athens Medical School, 68993National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Mamakos
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens Medical School, 68989National and Kapodistrian University of Athens, Athens, Greece
| | - Gerasimos Tsourouflis
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens Medical School, 68989National and Kapodistrian University of Athens, Athens, Greece.,Second Department of Propaedeutic Surgery, Laiko Hospital, Athens Medical School, 68993National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos I Nikiteas
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens Medical School, 68989National and Kapodistrian University of Athens, Athens, Greece.,Second Department of Propaedeutic Surgery, Laiko Hospital, Athens Medical School, 68993National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Dimitroulis
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens Medical School, 68989National and Kapodistrian University of Athens, Athens, Greece.,Second Department of Propaedeutic Surgery, Laiko Hospital, Athens Medical School, 68993National and Kapodistrian University of Athens, Athens, Greece
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Cai JP, Chen W, Chen LH, Wan XY, Lai JM, Yin XY. Comparison between robotic-assisted and laparoscopic left hemi-hepatectomy. Asian J Surg 2021; 45:265-268. [PMID: 34120821 DOI: 10.1016/j.asjsur.2021.05.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/26/2021] [Accepted: 05/17/2021] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To compare the safety and short-term outcomes between robotic-assisted and laparoscopic left hemi-hepatectomies in a single academic medical center. METHODS A cohort of 52 patients, who underwent robotic-assisted or laparoscopic left hemi-hepatectomies between April 2015 and January 2020 in Department of Pancreatobiliary Surgery, the First Affiliated Hospital of Sun Yat-Sen University was recruited into the study. Their clinicopathological features and short-term outcomes were analyzed retrospectively. RESULTS There were 25 robotic-assisted and 27 laparoscopic cases, with a median age of 55 years (34-77 years). There was one conversion to open in laparoscopic group. There were no significant differences in clinicopathological features between two groups, except robotic group had higher body mass index (23.9 vs. 22.0 kg/m2, p = 0.047). Robotic-assisted and laparoscopic groups had similar operative time (300 vs. 310 min, p = 0.515), length of hospital stay (8 vs. 8 days, p = 0.981) and complication rates (4.0% vs. 14.8%, p = 0.395), but the former had less blood loss (100 vs. 200 ml, p < 0.001) and lower incidence of blood transfusion (0% vs. 22.2%, p = 0.023) in comparison with laparoscopic group. R0 resection was achieved for all patients with malignancies. There was no perioperative mortality in both groups. The cost of robotic group was higher than laparoscopic group (105,870 vs. 64,191 RMB yuan, p = 0.02). CONCLUSION The robotic-assisted and laparoscopic approaches had similar safety and short-term outcomes in left hemi-hepatectomy, and the former can reduce operative blood loss and blood transfusion. However, the costs were higher in robotic group.
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Affiliation(s)
- Jian-Peng Cai
- Department of Pancreatobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Wei Chen
- Department of Pancreatobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Liu-Hua Chen
- Department of Pancreatobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xi-Yu Wan
- Department of Pancreatobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jia-Ming Lai
- Department of Pancreatobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Yu Yin
- Department of Pancreatobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
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32
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Safety and feasibility of robotic liver resection after previous abdominal surgeries. Surg Endosc 2021; 36:2842-2849. [PMID: 34076760 DOI: 10.1007/s00464-021-08572-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/18/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND While minimally invasive liver surgery has been increasingly adopted at least for minor resections, experience with robotic liver surgery is still limited to a few highly specialized centers. Due to the fear of abdominal adhesions, a history of prior surgeries is still used as an argument for open approaches. METHODS Clinical data of all consecutive robotic resections at our center, using the da Vinci Xi surgical system, between April, 2018 and December, 2020, were collected and analyzed as part of a prospective, post-marketing observational study (DRKS00017229). Prior abdominal surgeries were specified according to the surgical approach and localization. Baseline and perioperative outcome criteria were compared between patients with prior surgeries (PS) and patients with no prior surgeries (NPS) in univariate and multivariate analyses. RESULTS Out of the 126 patients undergoing robotic liver resections, 59% had a history of abdominal surgeries, which were most often colorectal resections (28%) followed by liver resections (20%). Patients with NPS were more likely to undergo robotic liver resection for hepatocellular carcinoma or benign tumors, and to have underlying liver cirrhosis when compared to patients with PS. Other baseline characteristics as well as the extent of resections were similar. Duration of surgery (258 min), conversion rates (6%), and postoperative complications rates (21% Clavien-Dindo ≥ 3) showed no differences between NPS and PS. A subgroup of patients with a history of prior liver surgery showed a longer duration of surgery in univariate analysis. However, this was not confirmed in multivariate analysis which instead revealed tumor entity and liver cirrhosis as independently correlated with duration of surgery. CONCLUSIONS We propose robotic liver resection to be safe and feasible, including in patients with prior abdominal surgeries. Each patient should be evaluated for a minimally invasive procedure regardless of a history of previous operations.
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Lorenz E, Arend J, Franz M, Rahimli M, Perrakis A, Negrini V, Gumbs AA, Croner RS. Robotic and laparoscopic liver resection-comparative experiences at a high-volume German academic center. Langenbecks Arch Surg 2021; 406:753-761. [PMID: 33834295 PMCID: PMC8106606 DOI: 10.1007/s00423-021-02152-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 03/15/2021] [Indexed: 01/21/2023]
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.
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Affiliation(s)
- E Lorenz
- Department of General, Visceral, Vascular, and Transplant Surgery, University Hospital Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany.
| | - J Arend
- Department of General, Visceral, Vascular, and Transplant Surgery, University Hospital Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany
| | - M Franz
- Department of General, Visceral, Vascular, and Transplant Surgery, University Hospital Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany
| | - M Rahimli
- Department of General, Visceral, Vascular, and Transplant Surgery, University Hospital Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany
| | - A Perrakis
- Department of General, Visceral, Vascular, and Transplant Surgery, University Hospital Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany
| | - V Negrini
- Department of General, Visceral, Vascular, and Transplant Surgery, University Hospital Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany
| | - A A Gumbs
- Centre Hospitalier Intercommunal de Poissy/Saint-Germain-En-Laye, 10 Rue du Champ Gaillard, 78300, Poissy, France
| | - R S Croner
- Department of General, Visceral, Vascular, and Transplant Surgery, University Hospital Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany
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Wang JM, Li JF, Yuan GD, He SQ. Robot-assisted versus laparoscopic minor hepatectomy: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25648. [PMID: 33907124 PMCID: PMC8084038 DOI: 10.1097/md.0000000000025648] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 02/14/2021] [Accepted: 03/17/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Robot-assisted and laparoscopic surgery are the most minimally invasive surgical approaches for the removal of liver lesions. Minor hepatectomy is a common surgical procedure. In this study, we evaluated the advantages and disadvantages of robot-assisted vs laparoscopic minor hepatectomy (LMH). METHODS A systematic literature search was performed in PubMed, Embase, and the Cochrane Library to identify comparative studies on robot-assisted vs. laparoscopicminor hepatectomy up to February, 2020. The odds ratios (OR) and mean differences with 95% confidence intervals were calculated using the fixed-effects model or random-effects model. RESULTS A total of 12 studies involving 751 patients were included in the meta-analysis. Among them, 297 patients were in the robot-assisted minor hepatectomy (RMH) group and 454 patients were in the LMH group. There were no significant differences in intraoperative blood loss (P = .43), transfusion rates (P = .14), length of hospital stay (P > .64), conversion rate (P = .62), R0 resection rate (P = .56), complications (P = .92), or mortaliy (P = .37) between the 2 groups. However, the RMH group was associated with a longer operative time (P = .0003), and higher cost (P < .00001) compared to the LMH group. No significant differences in overall survival or disease free survival between the 2 groups were observed. In the subgroup analysis of left lateral sectionectomies, RMH was still associated with a longer operative time, but no other differences in clinical outcomes were observed. CONCLUSIONS Although RMH is associated with longer operation times and higher costs, it exhibits the same safety and effectiveness as LMH. Prospective randomized controlled clinical trials should now be considered to obtain better evidence for clinical consensus.
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Clinical Outcomes of Robotic Surgery Compared to Conventional Surgical Approaches (Laparoscopic or Open): A Systematic Overview of Reviews. Ann Surg 2021; 273:467-473. [PMID: 32398482 DOI: 10.1097/sla.0000000000003915] [Citation(s) in RCA: 117] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Describe clinical outcomes (eg, postoperative complications, survival) after robotic surgery compared to open or laparoscopic surgery. BACKGROUND Robotic surgery utilization has increased over the years across a wide range of surgical procedures. However, evidence supporting improved clinical outcomes after robotic surgery is limited. METHODS We systematically searched MEDLINE, EMBASE, and the Cochrane Central Register of systematic reviews from inception to January 2019 for systematic reviews describing postoperative outcomes after robotic surgery. We qualitatively described patient outcomes of commonly performed robotic procedures: radical prostatectomy, hysterectomy, lobectomy, thymectomy, rectal resection, partial nephrectomy, distal gastrectomy, Roux-en-Y gastric bypass, hepatectomy, distal pancreatectomy, and cholecystectomy. RESULTS One hundred fifty-four systematic reviews included 336 studies and 18 randomized controlled trials reporting on patient outcomes after robotic compared to laparoscopic or open procedures. Data from the randomized controlled trials demonstrate that robotic-assisted radical prostatectomy offered fewer biochemical recurrence and improvement in quality of recovery and pain scores only up to 6 weeks postoperatively compared to open radical prostatectomy. When compared to laparoscopic prostatectomy, robotic surgery offered improved urinary and sexual functions. Robotic surgery for endometrial cancer had fewer conversion to open compared to laparoscopic. Otherwise, robotic surgery outcomes were similar to conventional surgical approaches for other procedures except for radical hysterectomy where minimally invasive approaches may result in patient harm compared to open approach. CONCLUSION Robotic surgery has been widely incorporated into practise despite limited supporting evidence. More rigorous research focused on patient-important benefits is needed before further expansion of robotic surgery.
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Golriz M, Flossmann V, Ramouz A, Majlesara A, Kulu Y, Stojkovic M, Mehrabi A. Case Report: Successful DaVinci-Assisted Major Liver Resection for Alveolar Echinococcosis. Front Surg 2021; 8:639304. [PMID: 33748182 PMCID: PMC7969883 DOI: 10.3389/fsurg.2021.639304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/03/2021] [Indexed: 12/02/2022] Open
Abstract
We report a case of successful robot-assisted major liver resection in a patient with liver alveolar echinococcosis (AE). A 62-year-old male patient was incidentally diagnosed with a large infiltrative lesion in the right liver lobe suspicious for AE. A radical surgical resection as a right-sided hemihepatectomy was indicated. The operation was carried out via a robotic-assisted procedure using the DaVinci Xi Surgical System. The tumor measured 12.4 × 8.8 cm and was successfully resected through a suprapubic incision of 13 cm. The patient was free of pain after the second post-operative day. A fluid collection near the resection plate was easily drained without bile leakage. The patient had no surgical complications. Radical resection is inevitable for adequate curative therapy of AE and provides clear margins. Robotic surgery is a relatively new and safe option for curative resection of AE lesions, with remarkable advantages for patients and surgeons.
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Affiliation(s)
- Mohammad Golriz
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Viktoria Flossmann
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Ali Ramouz
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Ali Majlesara
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Yakup Kulu
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Marija Stojkovic
- Department of Clinical Tropical Medicine, University of Heidelberg, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
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Hu Y, Guo K, Xu J, Xia T, Wang T, Liu N, Fu Y. Robotic versus laparoscopic hepatectomy for malignancy: A systematic review and meta-analysis. Asian J Surg 2021; 44:615-628. [PMID: 33468382 DOI: 10.1016/j.asjsur.2020.12.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/01/2020] [Accepted: 12/16/2020] [Indexed: 01/05/2023] Open
Abstract
The aim of this study was to compare the clinical safety and efficacy of robotic hepatectomy (RH) versus conventional laparoscopic hepatectomy (LH) for malignancy using meta-analysis. A systematic literature search was performed using PubMed, EMBASE, Medline and the Cochrane Library databases up to September 2020 for studies, which limited to comparative articles of RH or LH for malignant tumors. Stata14.0 was performed in the meta-analysis. Six studies with a total of 1093 patients (345 RH and 748 LH) were eligible for inclusion. Operative time, tumor size, open procedure rate and the proportion of right hepatectomy were found to be significantly different between RH and LH in the pooled analysis (P < 0.05). Compared to LH, RH was associated with longer operative time, larger tumor size, lower open procedure rate and more common use for right hepatectomy. On the other hand, there was no difference in the operative time, estimated blood loss (EBL), blood transfusion rate, hospital stay, R0 resection rate, complications, resection margin, left lateral sectionectomy and left hepatectomy (P > 0.05). For malignant tumors that require hepatectomy, robotic approaches have demonstrated similar safety and feasibility to laparoscopy, with lower open procedure rate, were suitable for larger tumor size, and have a high right hepatectomy utilization rate. These results still need to be confirmed by multicenter, high-quality randomized controlled studies.
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Affiliation(s)
- Yingnan Hu
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China; Jieshou Hospital of Traditional Chinese Medicine, China.
| | - Kaibo Guo
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jingming Xu
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Taotao Xia
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Tingting Wang
- Graduate School of Guangxi University of Chinese Medicine, Nanning, China
| | - Nan Liu
- School of Rehabilitation Medicine of Anhui University of Chinese Medicine, Hefei, China
| | - Yongqing Fu
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China; Department of Hepatobiliary Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
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Becker F, Morgül H, Katou S, Juratli M, Hölzen JP, Pascher A, Struecker B. Robotic Liver Surgery - Current Standards and Future Perspectives. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 59:56-62. [PMID: 33429451 DOI: 10.1055/a-1329-3067] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Robotic liver surgery is emerging as the future of minimal invasive surgery. The robotic surgical system offers a stable camera platform, elimination of physiologic tremor, augmented surgical dexterity as well as improved ergonomics because of a seated operating position. Due to the theoretical advantages of the robotic assisted system, complex liver surgery might be an especially interesting indication for a robotic approach since it demands delicate tissue dissection, precise intracorporeal suturing as well as difficult parenchymal transection with subsequent need for meticulous hemostasis and biliostasis. MATERIAL AND METHODS An analysis of English and German literature on open, laparoscopic and robotic liver surgery was performed and this review provides a general overview of the existing literature along with current standards and aims to specifically point out future directions of robotic liver surgery. RESULTS Robotic liver surgery is safe and feasible compared to open and laparoscopic surgery, with improved short-term postoperative outcomes and at least non-inferior oncological outcomes. CONCLUSION In complex cases including major hepatectomies, extended hepatectomies with biliary reconstruction and difficult segmentectomies of the posterior-superior segments, robotic surgery appears to emerge as a reasonable alternative to open surgery rather than being an alternative to laparoscopic procedures.
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Affiliation(s)
- Felix Becker
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Germany
| | - Haluk Morgül
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Germany
| | - Shadi Katou
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Germany
| | - Mazen Juratli
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Germany
| | - Jens Peter Hölzen
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Germany
| | - Andreas Pascher
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Germany
| | - Benjamin Struecker
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Germany
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Long-Term and Oncologic Outcomes of Robotic Versus Laparoscopic Liver Resection for Metastatic Colorectal Cancer: A Multicenter, Propensity Score Matching Analysis. World J Surg 2020; 44:887-895. [PMID: 31748885 DOI: 10.1007/s00268-019-05270-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND To assess long-term oncologic outcomes of robotic-assisted liver resection (RLR) for colorectal cancer (CRC) metastases as compared to a propensity-matched cohort of laparoscopic liver resections (LLR). Although safety and short-term outcomes of RLR have been described and previously compared to LLR, long-term and oncologic data are lacking. METHODS A retrospective study was performed of all patients who underwent RLR and LLR for CRC metastases at six high-volume centers in the USA and Europe between 2002 and 2017. Propensity matching was used to match baseline characteristics between the two groups. Data were analyzed with a focus on postoperative and oncologic outcomes, as well as long-term recurrence and survival. RESULTS RLR was performed in 115 patients, and 514 patients underwent LLR. Following propensity matching 115 patients in each cohort were compared. Perioperative outcomes including mortality, morbidity, reoperation, readmission, intensive care requirement, length-of-stay and margin status were not statistically different. Both prematching and postmatching analyses demonstrated similar overall survival (OS) and disease-free survival (DFS) between RLR and LLR at 5 years (61 vs. 60% OS, p = 0.87, and 38 vs. 31% DFS, p = 0.25, prematching; 61 vs. 60% OS, p = 0.78, and 38 vs. 44% DFS, p = 0.62, postmatching). CONCLUSIONS Propensity score matching with a large, multicenter database demonstrates that RLR for colorectal metastases is feasible and safe, with perioperative and long-term oncologic outcomes and survival that are largely comparable to LLR.
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De Raffele E, Mirarchi M, Cuicchi D, Lecce F, Casadei R, Ricci C, Selva S, Minni F. Simultaneous colorectal and parenchymal-sparing liver resection for advanced colorectal carcinoma with synchronous liver metastases: Between conventional and mini-invasive approaches. World J Gastroenterol 2020; 26:6529-6555. [PMID: 33268945 PMCID: PMC7673966 DOI: 10.3748/wjg.v26.i42.6529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 10/05/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023] Open
Abstract
The optimal timing of surgery in case of synchronous presentation of colorectal cancer and liver metastases is still under debate. Staged approach, with initial colorectal resection followed by liver resection (LR), or even the reverse, liver-first approach in specific situations, is traditionally preferred. Simultaneous resections, however, represent an appealing strategy, because may have perioperative risks comparable to staged resections in appropriately selected patients, while avoiding a second surgical procedure. In patients with larger or multiple synchronous presentation of colorectal cancer and liver metastases, simultaneous major hepatectomies may determine worse perioperative outcomes, so that parenchymal-sparing LR should represent the most appropriate option whenever feasible. Mini-invasive colorectal surgery has experienced rapid spread in the last decades, while laparoscopic LR has progressed much slower, and is usually reserved for limited tumours in favourable locations. Moreover, mini-invasive parenchymal-sparing LR is more complex, especially for larger or multiple tumours in difficult locations. It remains to be established if simultaneous resections are presently feasible with mini-invasive approaches or if we need further technological advances and surgical expertise, at least for more complex procedures. This review aims to critically analyze the current status and future perspectives of simultaneous resections, and the present role of the available mini-invasive techniques.
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Affiliation(s)
- Emilio De Raffele
- Division of Pancreatic Surgery, Department of Digestive Diseases, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, 40138 Bologna, Italy
| | - Mariateresa Mirarchi
- Dipartimento Strutturale Chirurgico, Ospedale SS Antonio e Margherita, 15057 Tortona (AL), Italy
| | - Dajana Cuicchi
- Surgery of the Alimentary Tract, Department of Digestive Diseases, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, 40138 Bologna, Italy
| | - Ferdinando Lecce
- Surgery of the Alimentary Tract, Department of Digestive Diseases, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, 40138 Bologna, Italy
| | - Riccardo Casadei
- Division of Pancreatic Surgery, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Claudio Ricci
- Division of Pancreatic Surgery, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Saverio Selva
- Division of Pancreatic Surgery, Department of Digestive Diseases, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, 40138 Bologna, Italy
| | - Francesco Minni
- Division of Pancreatic Surgery, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
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Zhao Z, Yin Z, Li M, Jiang N, Liu R. State of the art in robotic liver surgery: a meta-analysis. Updates Surg 2020; 73:977-987. [PMID: 33146887 DOI: 10.1007/s13304-020-00906-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 10/20/2020] [Indexed: 01/05/2023]
Abstract
Although the number of robotic hepatectomy (RH) performed is increasing, few studies have reported its efficacy in comparison with the conventional surgical modalities. The aim of this meta-analysis was to evaluate the perioperative results of RH vs. open hepatectomy (OH) and RH vs. laparoscopic hepatectomy (LH). We systematically searched for English papers published in PubMed (Medline), Embase, and Cochrane library before March 1, 2020. A total of 39 papers and 2999 patients were eventually included. Among the included patients, 1249, 1010, and 740 underwent RH, LH, and OH, respectively. Compared with OH, the operation time was significantly increased but the intraoperative blood loss, blood transfusion rate, incidence of severe complications, and length of postoperative hospitalization were significantly reduced in patients with RH. However, there was no significant difference in the use of Pringle maneuver and overall incidence of complications. Compared with LH, the operation time was significantly increased, and the intraoperative blood loss was also more in RH. However, there were no differences in blood transfusion rate, use of Pringle maneuver, incidence of complications, incidence of severe complications, and length of postoperative hospitalization between the two groups. A longer operation time remains the main shortcoming of RH. However, based on the perioperative clinical efficacy, we conclude that RH is comparable to LH but is better than OH for selected patients.
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Affiliation(s)
- Zhiming Zhao
- The Second Department of Hepatopancreatobiliary Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhuzeng Yin
- The Second Department of Hepatopancreatobiliary Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Mengyang Li
- Department of Hepatobiliary Surgery, The Fourth Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Nan Jiang
- The Second Department of Hepatopancreatobiliary Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Rong Liu
- The Second Department of Hepatopancreatobiliary Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China.
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Kawka M, Komor JK. A commentary on 'Laparoscopic hepatectomy is safe and effective for the management of patients with colorectal cancer liver metastases in a population-based analysis in Ontario, Canada. A retrospective cohort study' (Int J Surg 2020; 83:47-52). Int J Surg 2020; 84:96-97. [PMID: 33129996 DOI: 10.1016/j.ijsu.2020.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/22/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Michal Kawka
- Department of Medicine, Imperial College London, South Kensington Campus, London, SW7 2AZ, United Kingdom.
| | - Julia K Komor
- Department of Medicine, Imperial College London, South Kensington Campus, London, SW7 2AZ, United Kingdom
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Duarte VC, Coelho FF, Valverde A, Danoussou D, Kruger JAP, Zuber K, Fonseca GM, Jeismann VB, Herman P, Lupinacci RM. Minimally invasive versus open right hepatectomy: comparative study with propensity score matching analysis. BMC Surg 2020; 20:260. [PMID: 33126885 PMCID: PMC7602349 DOI: 10.1186/s12893-020-00919-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/20/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Minimally invasive liver resections (MILRs) have been increasingly performed in recent years. However, the majority of MILRs are actually minor or limited resections of peripheral lesions. Due to the technical complexity major hepatectomies remain challenging for minimally invasive surgery. The aim of this study was to compare the short and long-term outcomes of patients undergoing minimally invasive right hepatectomies (MIRHs) with contemporary patients undergoing open right hepatectomies (ORHs) METHODS: Consecutive patients submitted to anatomic right hepatectomies between January 2013 and December 2018 in two tertiary referral centers were studied. Study groups were compared on an intention-to-treat basis after propensity score matching (PSM). Overall survival (OS) analyses were performed for the entire cohort and specific etiologies subgroups RESULTS: During study period 178 right hepatectomies were performed. After matching, 37 patients were included in MIRH group and 60 in ORH group. The groups were homogenous for all baseline characteristics. MIRHs had significant lower blood loss (400 ml vs. 500 ml, P = 0.01), lower rate of minor complications (13.5% vs. 35%, P = 0.03) and larger resection margins (10 mm vs. 5 mm, P = 0.03) when compared to ORHs. Additionally, a non-significant decrease in hospital stay (ORH 9 days vs. MIRH 7 days, P = 0.09) was observed. No differences regarding the use of Pringle's maneuver, operative time, overall morbidity or perioperative mortality were observed. OS was similar between the groups (P = 0.13). Similarly, no difference in OS was found in subgroups of patients with primary liver tumors (P = 0.09) and liver metastasis (P = 0.80). CONCLUSIONS MIRHs are feasible and safe in experienced hands. Minimally invasive approach was associated with less blood loss, a significant reduction in minor perioperative complications, and did not negatively affect long-term outcomes.
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Affiliation(s)
- Vinícius Campos Duarte
- Liver Surgery Unit, Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, Rua Dr. Enéas de Carvalho Aguiar, 255-9º Andar-sala 9025, São Paulo, SP, CEP 05403-900, Brazil.
| | - Fabricio Ferreira Coelho
- Liver Surgery Unit, Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, Rua Dr. Enéas de Carvalho Aguiar, 255-9º Andar-sala 9025, São Paulo, SP, CEP 05403-900, Brazil
| | - Alain Valverde
- Digestive Surgery Unit, Diaconesses Croix Saint Simon Hospital, 125, Rue d'Avron, 75020, Paris, France
| | - Divia Danoussou
- Digestive Surgery Unit, Diaconesses Croix Saint Simon Hospital, 125, Rue d'Avron, 75020, Paris, France
| | - Jaime Arthur Pirola Kruger
- Liver Surgery Unit, Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, Rua Dr. Enéas de Carvalho Aguiar, 255-9º Andar-sala 9025, São Paulo, SP, CEP 05403-900, Brazil
| | - Kevin Zuber
- Research and Biostatistics Unit, Rothschild Foundation Hospital, Paris, France
| | - Gilton Marques Fonseca
- Liver Surgery Unit, Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, Rua Dr. Enéas de Carvalho Aguiar, 255-9º Andar-sala 9025, São Paulo, SP, CEP 05403-900, Brazil
| | - Vagner Birk Jeismann
- Liver Surgery Unit, Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, Rua Dr. Enéas de Carvalho Aguiar, 255-9º Andar-sala 9025, São Paulo, SP, CEP 05403-900, Brazil
| | - Paulo Herman
- Liver Surgery Unit, Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, Rua Dr. Enéas de Carvalho Aguiar, 255-9º Andar-sala 9025, São Paulo, SP, CEP 05403-900, Brazil
| | - Renato Micelli Lupinacci
- Digestive Surgery Unit, Diaconesses Croix Saint Simon Hospital, 125, Rue d'Avron, 75020, Paris, France.,AP-HP, Department of Digestive, Oncologic and Metabolic Surgery, Ambroise Paré Hospital, Boulogne-Billancourt, France.,Versailles St-Quentin-en-Yvelines/Paris Saclay University, UFR des Sciences de la Santé Simone Veil, Montigny-Le-Bretonneux, France
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Zhang L, Yuan Q, Xu Y, Wang W. Comparative clinical outcomes of robot-assisted liver resection versus laparoscopic liver resection: A meta-analysis. PLoS One 2020; 15:e0240593. [PMID: 33048989 PMCID: PMC7553328 DOI: 10.1371/journal.pone.0240593] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/30/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND As an emerging technology, robot-assisted surgical system has some potential merits in many complicated endoscopic procedures compared with laparoscopic surgery. But robot-assisted liver resection is still a controversial problem on its advantages compared with laparoscopic liver resection. We aimed to perform the meta-analysis to assess and compare the clinical outcomes of robot-assisted and laparoscopic liver resection. METHODS We searched PubMed, Cochrane Library, Embase databases, Clinicaltrials, and Opengrey through March 24, 2020, including references of qualifying articles. English-language, original investigations in humans about robot-assisted and laparoscopic hepatectomy were included. Titles, abstracts, and articles were reviewed by at least 2 independent readers. Continuous and dichotomous variables were compared by the weighted mean difference (WMD) and odds ratio (OR), respectively. RESULTS Of 936 titles identified in our original search, 28 articles met our criteria, involving 3544 patients. Compared with laparoscopy, the robot-assisted groups had longer operative time (WMD: 36.93; 95% CI, 19.74-54.12; P < 0.001), lower conversion rate (OR: 0.63; 95% CI, 0.46-0.87; P = 0.005), higher transfusion rate (WMD: 2.39; 95% CI, 1.51-3.76; P < 0.001) and higher total cost (WMD:0.49; 95% CI, 0.42-0.55; P < 0.001). In addition, the baseline characteristics of patients about largest tumor size was larger (WMD: 0.36; 95% CI, 0.16-0.56; P < 0.001) and malignant lesions rate was higher (WMD: 1.50; 95% CI, 1.21-1.86; P < 0.001) in the robot-assisted versus laparoscopic hepatectomy. The subgroup analysis of minor hepatectomy showed robot-assisted was associated with longer operative time (WMD: 36.00; 95% CI, 12.59-59.41; P = 0.003), longer length of stay (WMD: 0.51; 95% CI, 0.02-1.01; p = 0.04) and higher total cost (WMD: 0.48; 95% CI, 0.25-0.72; P < 0.001) (Table 3); while the subgroup analysis of major hepatectomy showed robot-assisted was associated with lower estimated blood loss (WMD: -122.43; 95% CI, -151.78--93.08; P < 0.001). CONCLUSIONS Our meta-analysis revealed that robot-assisted was associated with longer operative time, lower conversion rate, higher transfusion rate and total cost, and robot-assisted has certain advantages in major hepatectomy compared with laparoscopic hepatectomy.
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Affiliation(s)
- Lilong Zhang
- Department of Hepatobiliary and Laparoscopic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Qihang Yuan
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yao Xu
- Surgical Intensive Care Unit (SICU), Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Weixing Wang
- Department of Hepatobiliary and Laparoscopic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
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Ziogas IA, Giannis D, Esagian SM, Economopoulos KP, Tohme S, Geller DA. Laparoscopic versus robotic major hepatectomy: a systematic review and meta-analysis. Surg Endosc 2020; 35:524-535. [DOI: 10.1007/s00464-020-08008-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 09/16/2020] [Indexed: 02/08/2023]
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Camerlo A, Magallon C, Vanbrugghe C, Chiche L, Gaudon C, Rinaldi Y, Fara R. Robotic hepatic parenchymal transection: a two-surgeon technique using ultrasonic dissection and irrigated bipolar coagulation. J Robot Surg 2020; 15:539-546. [PMID: 32779132 DOI: 10.1007/s11701-020-01138-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/03/2020] [Indexed: 02/06/2023]
Abstract
Liver transection is the most challenging part of hepatectomy due to the risk of hemorrhage which is associated with postoperative morbidity and mortality and reduced long-term survival. Parenchymal ultrasonic dissection (UD) with bipolar coagulation (BPC) has been widely recognized as a safe, effective, and standard technique during open and laparoscopic hepatectomy. We here introduce our technique of robotic liver transection using UD with BPC and report on short-term perioperative outcomes. From a single-institution prospective liver surgery database, we identified patients who underwent robotic liver resection. Demographic, anesthetic, perioperative, and oncologic data were analyzed. Fifty patients underwent robotic liver resection using UD and BPC for liver malignancies (n = 42) and benign lesions (n = 8). The median age of the patients was 67 years and 28 were male. According to the difficulty scoring system, 60% (n = 30) of liver resection were considered difficult. Three cases (6%) were converted to open surgery. The median operative time was 240 min, and the median estimated blood loss was 200 ml; 2 patients required operative transfusions. The overall complication rate was 38% (grade I, 29; grade II, 15; grade III, 3; grade IV, 1). Seven patients (14%) experienced biliary leakage. The median length of hospital stay post-surgery was 7 (range 3-20) days. The R0 resection rate was 92%. Robotic parenchymal transection using UD and irrigated BPC appears a simple, safe, and effective technique. However, our results must be confirmed in larger series or in randomized controlled trials.
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Affiliation(s)
- Antoine Camerlo
- Department of Digestive Surgery Hôpital Européen, 6 rue désirée Clary, 13003, Marseille, France.
| | - Cloé Magallon
- Department of Digestive Surgery Hôpital Européen, 6 rue désirée Clary, 13003, Marseille, France
| | - Charles Vanbrugghe
- Department of Digestive Surgery Hôpital Européen, 6 rue désirée Clary, 13003, Marseille, France
| | - Laurent Chiche
- Department of Clinical Research Hôpital Européen, 6 rue désirée Clary, 13003, Marseille, France
| | - Chloé Gaudon
- Department of Radiology Hôpital Européen, 6 rue désirée Clary, 13003, Marseille, France
| | - Yves Rinaldi
- Department of Digestive Surgery Hôpital Européen, 6 rue désirée Clary, 13003, Marseille, France
| | - Régis Fara
- Department of Digestive Surgery Hôpital Européen, 6 rue désirée Clary, 13003, Marseille, France
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Kamarajah SK, Bundred J, Manas D, Jiao LR, Hilal MA, White SA. Robotic Versus Conventional Laparoscopic Liver Resections: A Systematic Review and Meta-Analysis. Scand J Surg 2020; 110:290-300. [PMID: 32762406 DOI: 10.1177/1457496920925637] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Theoretical advantages of robotic surgery compared to conventional laparoscopic surgery include improved instrument dexterity, 3D visualization, and better ergonomics. This systematic review and meta-analysis aimed to determine advantages of robotic surgery over laparoscopic surgery in patients undergoing liver resections. METHOD A systematic literature search was conducted for studies comparing robotic assisted or totally laparoscopic liver resection. Meta-analysis of intraoperative (operative time, blood loss, transfusion rate, conversion rate), oncological (R0 resection rates), and postoperative (bile leak, surgical site infection, pulmonary complications, 30-day and 90-day mortality, length of stay, 90-day readmission and reoperation rates) outcomes was performed using a random effects model. RESULT Twenty-six non-randomized studies including 2630 patients (950 robotic and 1680 laparoscopic) were included, of which 20% had major robotic liver resection and 14% had major laparoscopic liver resection. Intraoperatively, robotic liver resection was associated with significantly less blood loss (mean: 286 vs 301 mL, p < 0.001) but longer operating time (mean: 281 vs 221 min, p < 0.001). There were no significant differences in conversion rates or transfusion rates between robotic liver resection and laparoscopic liver resection. Postoperatively, there were no significant differences in overall complications, bile leaks, and length of hospital stay between robotic liver resection and laparoscopic liver resection. However, robotic liver resection was associated with significantly lower readmission rates than laparoscopic liver resection (odds ratio: 0.43, p = 0.005). CONCLUSION Robotic liver resection appears to offer some advantages compared to conventional laparoscopic surgery, although both techniques appear equivalent. Importantly, the quality of evidence is generally limited to cohort studies and a high-quality randomized trial comparing both techniques is needed.
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Affiliation(s)
- S K Kamarajah
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Department of Surgery, The Freeman Hospital, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, University of Newcastle, Newcastle upon Tyne, UK
| | - J Bundred
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - D Manas
- Institute of Cellular Medicine, University of Newcastle, Newcastle upon Tyne, UK
| | - L R Jiao
- Department of Surgery and Cancer, HPB Surgical Unit, Imperial College, Hammersmith Hospital Campus, London, UK
| | - M A Hilal
- Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, UK
| | - S A White
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Department of Surgery, The Freeman Hospital, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, University of Newcastle, Newcastle upon Tyne, UK
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Comparison of the learning curves for robotic left and right hemihepatectomy: A prospective cohort study. Int J Surg 2020; 81:19-25. [PMID: 32739547 DOI: 10.1016/j.ijsu.2020.07.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/11/2020] [Accepted: 07/07/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Robotic hepatectomy has been continuously improving and shown to be safe and reliable. The learning curve of robotic hemihepatectomy is required which enable beginners to benefit from previous experience. The aim of this study was to assess the learning curve of robotic left (RLH) and right hemihepatectomy (RRH) in terms of operative time (OT) to determine which procedure has an easier learning curve for beginners. METHODS Data records for each 100 consecutive patients who underwent RLH and RRH between July 2012 and May 2019 were collected prospectively and analyzed retrospectively. The data included demographics, OT, estimated blood loss (EBL), postoperative hospital stay (PHS), and rates of morbidity and mortality. The cumulative sum method was used to evaluate the learning curve of OT. RESULTS All patients underwent the RRH and RLH procedure performed by the same surgical team. RRH and RLH learning curve consisted of two phases: the first and second phase. The first phase of RRH included 45 patients, while RLH outcomes were optimized after 35 cases were completed. Compared with the first phase, the mean OT and the median blood loss were decreased significantly in the second phase in both learning curves. No significant decrease in the rates of morbidity and conversion to laparotomy or PHS was observed. CONCLUSIONS This study demonstrated the safety and feasibility of RLH and RRH. The surgeons who previously lacked robotic experience are able to overcome the learning curve for RLH faster than RRH.
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Sucandy I, Giovannetti A, Ross S, Rosemurgy A. Institutional First 100 Case Experience and Outcomes of Robotic Hepatectomy for Liver Tumors. Am Surg 2020. [DOI: 10.1177/000313482008600328] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The nascent robotic approach for hepatic resections is gaining momentum in the United States because it offers solutions to the known limitations of laparoscopic approach. Herein, we report our initial experience and short-term outcomes of the first 100 robotic hepatectomies. With Institutional Review Board approval, all patients undergoing robotic hepatectomy were prospectively followed up. Patient demographics, operative outcomes, complications, and 30-day readmissions were collected and analyzed. Data are presented as median (mean ± SD). One hundred consecutive patients underwent robotic hepatectomy. Patients were aged 62 (63 ± 13.6) years, 66 per cent were women, and BMI was 29 (29 ± 6.4) kg/m2. In all, 76 per cent of the hepatectomies were undertaken for malignancy [metastatic colorectal cancer (28%), hepatocellular carcinoma (21%), and intrahepatic cholangiocarcinoma (15%)], and 20 per cent for benign lesions; 66 per cent of patients underwent nonanatomical partial hepatectomies, 17 per cent right hepatectomies, 16 per cent left hepatectomies, and 1 per cent trisegmentectomy. Operative time was 233 (268 ± 109.3) minutes, and the estimated blood loss was 123 (269 ± 322.1) mL. Conversion to “open” approach was necessary in one patient. The length of stay was 3 (5 ± 4.6) days. There were no intraoperative complications. Twelve patients experienced postoperative complications. Six patients required readmission to the hospital within 30 days of discharge. Robotic hepatectomy is safe and feasible with favorable short-term outcomes. The robotic system enhances application of minimally invasive surgery for complex hepatobiliary operations.
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Affiliation(s)
- Iswanto Sucandy
- From the Digestive Health Institute, AdventHealth Tampa, University of Central Florida, Tampa, Florida
| | - Andres Giovannetti
- From the Digestive Health Institute, AdventHealth Tampa, University of Central Florida, Tampa, Florida
| | - Sharona Ross
- From the Digestive Health Institute, AdventHealth Tampa, University of Central Florida, Tampa, Florida
| | - Alexander Rosemurgy
- From the Digestive Health Institute, AdventHealth Tampa, University of Central Florida, Tampa, Florida
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Kose E, Karahan SN, Berber E. Robotic Liver Resection: Recent Developments. CURRENT SURGERY REPORTS 2020. [DOI: 10.1007/s40137-020-00254-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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