World Journal of Surgery

, Volume 41, Issue 2, pp 516–524 | Cite as

Robotic-Assisted Versus Laparoscopic Left Lateral Sectionectomy: Analysis of Surgical Outcomes and Costs by a Propensity Score Matched Cohort Study

  • Chady Salloum
  • Chetana Lim
  • Eylon Lahat
  • Concepcion Gomez I. Gavara
  • Eric Levesque
  • Philippe Compagnon
  • Daniel Azoulay
Original Scientific Report



After comparing with open approach, left lateral sectionectomy (LLS) has become standard in terms of short-term outcomes without jeopardizing long-term survival when performed for malignancy. The aim of this study was to compare the short-term and economic outcomes of laparoscopic (L-LLS) and robotic (R-LLS) LLS.


All consecutive patients who underwent L-LLS or R-LLS from 1997 to 2014 were analyzed. Short-term and economic outcomes were compared between the two groups using a propensity score matching (PSM).


Ninety-six consecutive cases of LLS were performed using the laparoscopic (80 cases; 83 %) or robotic (16 cases; 17 %) approach. The two groups were similar for operative and surgical outcomes. Operation time was similar in the R-LLS compared to the L-LLS group (190 vs. 162 min; p = 0.10). Perioperative costs were higher (1457 € vs. 576 €; p < 0.0001) in the R-LLS group than in the L-LLS group; however, postoperative costs were similar between the two groups (4065 € in the R-LLS group vs. 5459 € in the L-LLS group; p = 0.30). Total costs were similar between the two groups (5522 € in the R-LLS group vs. 6035€ in the L-LLS group; p = 0.70). The PSM included 14 patients for each group. Surgical and economic outcomes remained similar after PSM, except for total operating time which was significantly longer in the R-LLS group than in the L-LLS group.


Even if feasible and safe, the robotic approach does not seem so far to offer additional benefit in terms of intra- and postoperative outcomes over the laparoscopic approach in patients requiring LLS. Total costs associated with the R-LLS group are not greater than that associated with the L-LLS group, which is the standard of care so far.


  1. 1.
    Cleary SP, Han HS, Yamamoto M et al (2016) The comparative costs of laparoscopic and open liver resection: a report for the 2nd international consensus conference on laparoscopic liver resection. Surg Endosc. doi: 10.1007/s00464-016-4801-5
  2. 2.
    Mirnezami R, Mirnezami AH, Chandrakumaran K et al (2011) Short- and long-term outcomes after laparoscopic and open hepatic resection: systematic review and meta-analysis. HPB (Oxford) 13(5):295–308CrossRefGoogle Scholar
  3. 3.
    Nguyen KT, Laurent A, Dagher I et al (2009) Minimally invasive liver resection for metastatic colorectal cancer: a multi-institutional, international report of safety, feasibility, and early outcomes. Ann Surg 250(5):842–848CrossRefPubMedGoogle Scholar
  4. 4.
    Nota CL, Rinkes IH, Molenaar IQ et al (2016) Robot-assisted laparoscopic liver resection: a systematic review and pooled analysis of minor and major hepatectomies. HPB (Oxford) 18(2):113–120CrossRefGoogle Scholar
  5. 5.
    Montalti R, Berardi G, Patriti A et al (2015) Outcomes of robotic vs laparoscopic hepatectomy: a systematic review and meta-analysis. World J Gastroenterol 21(27):8441–8451CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Qiu J, Chen S, Chengyou D (2015) A systematic review of robotic-assisted liver resection and meta-analysis of robotic versus laparoscopic hepatectomy for hepatic neoplasms. Surg Endosc 30(3):862–875CrossRefPubMedGoogle Scholar
  7. 7.
    Lee MKT, Gao F, Strasberg SM (2014) Perceived complexity of various liver resections: results of a survey of experts with development of a complexity score and classification. J Am Coll Surg 220(1):64–69CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Buell JF, Cherqui D, Geller DA et al (2009) The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg 250(5):825–830CrossRefPubMedGoogle Scholar
  9. 9.
    Wakabayashi G, Cherqui D, Geller DA et al (2015) Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 261(4):619–629PubMedGoogle Scholar
  10. 10.
    Ratti F, Barkhatov LI, Tomassini F et al (2015) Learning curve of self-taught laparoscopic liver surgeons in left lateral sectionectomy: results from an international multi-institutional analysis on 245 cases. Surg Endosc 30(8):3618–3629Google Scholar
  11. 11.
    Berber E, Akyildiz HY, Aucejo F et al (2010) Robotic versus laparoscopic resection of liver tumours. HPB (Oxford) 12(8):583–586CrossRefGoogle Scholar
  12. 12.
    Ji WB, Wang HG, Zhao ZM et al (2011) Robotic-assisted laparoscopic anatomic hepatectomy in China: initial experience. Ann Surg 253(2):342–348CrossRefPubMedGoogle Scholar
  13. 13.
    Chan OC, Tang CN, Lai EC et al (2011) Robotic hepatobiliary and pancreatic surgery: a cohort study. J Hepatobiliary Pancreat Sci 18(4):471–480CrossRefPubMedGoogle Scholar
  14. 14.
    Kandil E, Noureldine SI, Saggi B, Buell JF (2013) Robotic liver resection: initial experience with three-arm robotic and single-port robotic technique. JSLS 17(1):56–62CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Lai EC, Yang GP, Tang CN (2013) Robot-assisted laparoscopic liver resection for hepatocellular carcinoma: short-term outcome. Am J Surg 205(6):697–702CrossRefPubMedGoogle Scholar
  16. 16.
    Packiam V, Bartlett DL, Tohme S et al (2012) Minimally invasive liver resection: robotic versus laparoscopic left lateral sectionectomy. J Gastrointest Surg 16(12):2233–2238CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Tranchart H, Ceribelli C, Ferretti S et al (2014) Traditional versus robot-assisted full laparoscopic liver resection: a matched-pair comparative study. World J Surg 38(11):2904–2909CrossRefPubMedGoogle Scholar
  18. 18.
    Tsung A, Geller DA, Sukato DC et al (2014) Robotic versus laparoscopic hepatectomy: a matched comparison. Ann Surg 259(3):549–555CrossRefPubMedGoogle Scholar
  19. 19.
    Yu YD, Kim KH, Jung DH et al (2014) Robotic versus laparoscopic liver resection: a comparative study from a single center. Langenbecks Arch Surg 399(8):1039–1045CrossRefPubMedGoogle Scholar
  20. 20.
    Casciola L, Patriti A, Ceccarelli G et al (2011) Robot-assisted parenchymal-sparing liver surgery including lesions located in the posterosuperior segments. Surg Endosc 25(12):3815–3824CrossRefPubMedGoogle Scholar
  21. 21.
    Spampinato MG, Coratti A, Bianco L et al (2014) Perioperative outcomes of laparoscopic and robot-assisted major hepatectomies: an Italian multi-institutional comparative study. Surg Endosc 28(10):2973–2979CrossRefPubMedGoogle Scholar
  22. 22.
    Yu YD, Kim KH, Jung DH et al (2014) Robotic versus laparoscopic liver resection: a comparative study from a single center. Langenbeck’s Arch Surg 399(8):1039–1045CrossRefGoogle Scholar
  23. 23.
    Kim JK, Park JS, Han DH et al (2016) Robotic versus laparoscopic left lateral sectionectomy of liver. Surg Endosc. doi: 10.1007/s00464-016-4803-3
  24. 24.
    Lee KF, Cheung YS, Chong CC et al (2015) Laparoscopic and robotic hepatectomy: experience from a single centre. ANZ J Surg 86(3):122–126CrossRefPubMedGoogle Scholar
  25. 25.
    Cherqui D, Husson E, Hammoud R et al (2000) Laparoscopic liver resections: a feasibility study in 30 patients. Ann Surg 232(6):753–762CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Cherqui D (2003) Laparoscopic liver resection. Br J Surg 90(6):644–646CrossRefPubMedGoogle Scholar
  27. 27.
    Lesurtel M, Cherqui D, Laurent A et al (2003) Laparoscopic versus open left lateral hepatic lobectomy: a case-control study. J Am Coll Surg 196(2):236–242CrossRefPubMedGoogle Scholar
  28. 28.
    Chang S, Laurent A, Tayar C et al (2007) Laparoscopy as a routine approach for left lateral sectionectomy. Br J Surg 94(1):58–63CrossRefPubMedGoogle Scholar
  29. 29.
    Bryant R, Laurent A, Tayar C, Cherqui D (2009) Laparoscopic liver resection-understanding its role in current practice: the Henri Mondor Hospital experience. Ann Surg 250(1):103–111CrossRefPubMedGoogle Scholar
  30. 30.
    Salloum C, Lim C, Azoulay D (2015) Robot-assisted laparoscopic left lateral sectionectomy for benign and malignant liver tumors. J Visc Surg 152(6):373–378CrossRefPubMedGoogle Scholar
  31. 31.
    Tsung A, Geller DA, Sukato DC et al (2013) Robotic versus laparoscopic hepatectomy: a matched comparison. Ann Surg 259(3):549–555CrossRefGoogle Scholar
  32. 32.
    de’Angelis N, Alghamdi S, Renda A et al (2015) Initial experience of robotic versus laparoscopic colectomy for transverse colon cancer: a matched case-control study. World J Surg Oncol 13:295CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Balzan S, Belghiti J, Farges O et al (2005) The “50-50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg 242(6):824–828, discussion 828–829Google Scholar
  34. 34.
    Ishak K, Baptista A, Bianchi L et al (1995) Histological grading and staging of chronic hepatitis. J Hepatol 22(6):696–699CrossRefPubMedGoogle Scholar
  35. 35.
    Lonjon G, Boutron I, Trinquart L et al (2013) Comparison of treatment effect estimates from prospective nonrandomized studies with propensity score analysis and randomized controlled trials of surgical procedures. Ann Surg 259(1):18–25CrossRefGoogle Scholar
  36. 36.
    Ocuin LM, Tsung A (2015) Robotic liver resection for malignancy: current status, oncologic outcomes, comparison to laparoscopy, and future applications. J Surg Oncol 112(3):295–301CrossRefPubMedGoogle Scholar
  37. 37.
    Fernandes E, Elli E, Giulianotti P (2014) The role of the dual console in robotic surgical training. Surgery 155(1):1–4CrossRefPubMedGoogle Scholar
  38. 38.
    Scatton O, Katsanos G, Boillot O et al (2014) Pure laparoscopic left lateral sectionectomy in living donors: from innovation to development in France. Ann Surg 261(3):506–512CrossRefGoogle Scholar
  39. 39.
    Aikawa M, Miyazawa M, Okamoto K et al (2012) Single-port laparoscopic hepatectomy: technique, safety, and feasibility in a clinical case series. Surg Endosc 26(6):1696–1701CrossRefPubMedGoogle Scholar
  40. 40.
    Shetty GS, You YK, Choi HJ et al (2012) Extending the limitations of liver surgery: outcomes of initial human experience in a high-volume center performing single-port laparoscopic liver resection for hepatocellular carcinoma. Surg Endosc 26(6):1602–1608CrossRefPubMedGoogle Scholar
  41. 41.
    Gavriilidis P, Lim C, Menahem B et al (2016) Robotic versus laparoscopic distal pancreatectomy—the first meta-analysis. HPB (Oxford) 18(7):567–574CrossRefGoogle Scholar
  42. 42.
    Valente R, Azoulay D (2015) Is multimodality the “Third Way” in the challenge robot versus laparoscopy for liver resections? Ann Surg. doi: 10.1097/SLA.0000000000000922
  43. 43.
    Giulianotti PC, Bianco FM, Daskalaki D et al (2016) Robotic liver surgery: technical aspects and review of the literature. Hepatobiliary Surg Nutr 5(4):311–321CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Salloum C, Lim C, Fuentes L et al (2016) Fusion of information from 3D printing and surgical robot: an innovative minimally technique illustrated by the resection of a large celiac trunk aneurysm. World J Surg 40(1):245–247CrossRefPubMedGoogle Scholar
  45. 45.
    Alaraimi B, El Bakbak W, Sarker S et al (2014) A randomized prospective study comparing acquisition of laparoscopic skills in three-dimensional (3D) vs. two-dimensional (2D) laparoscopy. World J Surg 38(11):2746–2752CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2016

Authors and Affiliations

  • Chady Salloum
    • 1
  • Chetana Lim
    • 1
  • Eylon Lahat
    • 1
  • Concepcion Gomez I. Gavara
    • 1
  • Eric Levesque
    • 3
  • Philippe Compagnon
    • 1
    • 2
  • Daniel Azoulay
    • 1
    • 2
  1. 1.Department of Hepato-Biliary and Pancreatic Surgery and Liver TransplantationAP-HP Henri Mondor HospitalCréteilFrance
  2. 2.INSERM 955CréteilFrance
  3. 3.Department of Anesthesia and Liver Intensive Care UnitAP-HP Henri Mondor HospitalCréteilFrance

Personalised recommendations