Robotic Liver Resection: A Case-Matched Comparison
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In recent years, increasingly sophisticated tools have allowed for more complex robotic surgery. Robotic hepatectomy, however, is still in its infancy. Our goals were to examine the adoption of robotic hepatectomy and to compare outcomes between open and robotic liver resections.
The robotic hepatectomy experience of 64 patients was compared to a modern case-matched series of 64 open hepatectomy patients at the same center. Matching was according to benign/malignant diagnosis and number of segments resected. Patient data were obtained retrospectively. The main outcomes and measures were operative time, estimated blood loss, conversion rate (robotic to open), Pringle maneuver use, single non-anatomic wedge resection rate, resection margin size, complication rates (infectious, hepatic, pulmonary, cardiac), hospital stay length, ICU stay length, readmission rate, and 90-day mortality rate.
Sixty-four robotic hepatectomies were performed in 2010–2014. Forty-one percent were segmental and 34 % were wedge resections. There was a 6 % conversion rate, a 3 % 90-day mortality rate, and an 11 % morbidity rate. Compared to 64 matched patients who underwent open hepatectomy (2004–2012), there was a shorter median OR time (p = 0.02), lower median estimated blood loss (p < 0.001), and shorter median hospital stay (p < 0.001). Eleven of the robotic cases were isolated resections of tumors in segments 2, 7, and 8.
Robotic hepatectomy is safe and effective. Increasing experience in more centers will allow definition of which hepatectomies can be performed robotically, and will enable optimization of outcomes and prospective examination of the economic cost of each approach.
KeywordsLiver Resection Inferior Vena Cava Laparoscopic Liver Resection Robotic Group Memorial Sloan Kettering Cancer Center
This study was supported in part by a grant from the California Institute for Regenerative Medicine (YF), and by two grants from the US National Institutes of Health: P30 CA033572 (YF) and P30 CA008748 (Cancer Center Support Grant).
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Conflicts of interest
Dr. Yuman Fong is a Scientific Advisor to both Covidien and Perfint. Drs. Kingham, Leung, Kuk, Gönen, D’Angelica, Allen, DeMatteo, Laudone, and Jarnagin have no conflicts of interest or financial ties to disclose.