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Robotic versus laparoscopic liver resection in posterosuperior region: a retrospective study of consecutive cases

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Abstract

Background

Minimally invasive liver resection of the posterosuperior region is considered a challenging procedure due to poor exposure and difficult bleeding control. A robotic approach is supposed to be advantageous in posterosuperior segmentectomy. Its benefits over laparoscopic liver resection (LLR) remain undetermined. This study compared robotic liver resection (RLR) and LLR in the posterosuperior region performed by a single surgeon.

Materials and methods

We retrospectively analyzed consecutive RLR and LLR performed by a single surgeon between December 2020 and March 2022. Patient characteristics and perioperative variables were compared. A 1:1 propensity score matched (PSM) analysis was performed between both groups.

Results

The analysis included 48 RLR and 57 LLR procedures in the posterosuperior region. After PSM analysis, 41 cases of both groups were retained. In pre-PSM cohort, the operative time in the RLR group was significantly shorter than in the LLR group (160 vs. 208 min, P = 0.001), especially in radical resection of malignant tumors (176 vs. 231 min, P = 0.004). The total Pringle maneuver duration was also markedly shorter (40 vs. 51 min, P = 0.047), and the estimated blood loss in the RLR group was lower (92 vs. 150 mL, P = 0.005). The postoperative hospital stay (POHS) in the RLR group was significantly shorter (5.4 vs. 7.5 days, P = 0.048). In PSM cohort, operative time in the RLR group was also significantly shorter (163 vs. 193 min, P = 0.036), and the estimated blood loss was lower (92 vs. 144 mL, P = 0.024). However, the total Pringle maneuver duration and POHS showed no significant difference. The complications were similar between two groups in both pre-PSM and PSM cohorts.

Conclusion

RLR in the posterosuperior region was as safe and feasible as LLR. RLR was associated with reduced operative time and blood loss than LLR.

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Funding

This research was supported by the National Natural Science Foundation of China [81871925 and 82071867], the Key Research and Development Program of Zhejiang Province [2020C03117] and the Natural Science Foundation of Zhejiang Province [LQ22H160044, LY21H160037 and LZ22H030003].

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Author notes

  1. Wei Chen and Xiaoyu Zhang have contributed equally to this work.

Authors and Affiliations

  1. Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, China

    Wei Chen, Xiaoyu Zhang, Jincai Jiang, Yufu Ye, Zhenglong Zhai, Wendi Hu, Xiang Li, Yiwen Chen, Yan Chen, Yifan Hong, Lan Jia, Xueli Bai & Tingbo Liang

  2. Zhejiang Provincial Key Laboratory of Pancreatic Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Xueli Bai & Tingbo Liang

  3. Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Diseases, Hangzhou, China

    Xueli Bai & Tingbo Liang

  4. The Innovation Center for the Study of Pancreatic Diseases of Zhejiang Province, Hangzhou, China

    Tingbo Liang

  5. Cancer Center, Zhejiang University, Hangzhou, China

    Tingbo Liang

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  1. Wei Chen
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Corresponding author

Correspondence to Xueli Bai.

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Wei Chen, Xiaoyu Zhang, Jincai Jiang, Yufu Ye, Wendi Hu, Zhenglong Zhai, Xiang Li, Yiwen Chen, Yan Chen, Yifan Hong, Lan Jia, Xueli Bai, Tingbo Liang have no conflicts of interest or financial ties to disclose.

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Chen, W., Zhang, X., Jiang, J. et al. Robotic versus laparoscopic liver resection in posterosuperior region: a retrospective study of consecutive cases. Surg Endosc 37, 4728–4736 (2023). https://doi.org/10.1007/s00464-023-09952-5

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