Surgical Endoscopy

, Volume 28, Issue 10, pp 2973–2979 | Cite as

Perioperative outcomes of laparoscopic and robot-assisted major hepatectomies: an Italian multi-institutional comparative study

  • Marcello Giuseppe Spampinato
  • Andrea Coratti
  • Luigi Bianco
  • Fabio Caniglia
  • Andrea Laurenzi
  • Francesco Puleo
  • Giuseppe Maria Ettorre
  • Ugo Boggi
Article

Abstract

Background

Laparoscopic major hepatectomy (LMH), although safely feasible in experienced hands and in selected patients, is a formidable challenge because of the technical demands of controlling hemorrhage, sealing bile ducts, avoiding gas embolism, and maintaining oncologic surgical principles. The enhanced surgical dexterity offered by robotic assistance could improve feasibility and/or safety of minimally invasive major hepatectomy. The aim of this study was to compare perioperative outcomes of LMH and robotic-assisted major hepatectomy (RMH).

Methods

Pooled data from four Italian hepatobiliary centers were analyzed retrospectively. Demographic data, operative, and postoperative outcomes were collected from prospectively maintained databases and compared.

Results

Between January 2009 and December 2012, 25 patients underwent LMH and 25 RMH. The two groups were comparable for all baseline characteristics including type of resection and underlying pathology. Conversion to open surgery was required in one patient in each group (4 %). No difference was noted in operative time, estimated blood, and need for allogenic blood transfusions. Intermittent pedicle occlusion was required only in LMH (32 % vs. 0; p = 0.004). Length of hospital stay, including time spent in intensive care unit, was similar between the two groups, but patients undergoing LMH showed quicker recovery of bowel activity, with shorter time to first flatus (1 vs. 3 days; p = 0.023) and earlier tolerance to oral liquid diet (1 vs. 2 days; p = 0.001). No difference was noted in complication rate, 90-day mortality, and readmission rate.

Conclusions

This retrospective multi-institution study confirms that selected patients can safely undergo minimally invasive major hepatectomy, either LMH or RMH. The fact that intermittent pedicle occlusion could be avoided in RMH suggests improved surgical ability to deal with bleeding during liver transection, but further studies are needed before any final conclusion can be drawn.

Keywords

Laparoscopic liver resection Robotic liver resection Minimally invasive liver surgery Major hepatectomies Robotic hepatectomy Laparoscopic hepatectomy 

Notes

Disclosures

Marcello G Spampinato, Andrea Coratti, Luigi Bianco, Fabio Caniglia, Andrea Laurenzi, Giuseppe Maria Ettorre, and Ugo Boggi have no conflicts of interest or financial ties to disclose. Dr. Francesco Puleo is currently granted by Fond Erasme, Brussels, Belgium.

References

  1. 1.
    Reich H, McGlynn F, DeCaprio J, Budin R (1991) Laparoscopic excision of benign liver lesions. Obstet Gynecol 78:956–958PubMedGoogle Scholar
  2. 2.
    Nguyen KT, Laurent A, Dagher I, Geller DA, Steel J, Thomas MT et al (2009) Minimally invasive liver resection for metastatic colorectal cancer: a multi-institutional, international report of safety, feasibility, and early outcomes. Ann Surg. 250:842–848PubMedCrossRefGoogle Scholar
  3. 3.
    Hu BS, Chen K, Tan HM, Ding XM, Tan JW (2011) Comparison of laparoscopic vs open liver lobectomy (segmentectomy) for hepatocellular carcinoma. World J Gastroenterol 17:4725–4728PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Belli G, Fantini C, D’Agostino A, Belli A, Russolillo N (2004) Laparoscopic liver resections for hepatocellular carcinoma (HCC) in cirrhotic patients. HPB (Oxford) 6:236–246CrossRefGoogle Scholar
  5. 5.
    Gigot JF, Glineur D, Santiago AJ, Goergen M, Ceuterick M, Morino M, Etienne J, Marescaux J, Mutter D, Van Krunckelsven D, Descottes B, Valleix D, Lachachi F, Bertrand C, Mansvelt B, Hubens G, Saey JP, Schockmel R, Hepatobiliary and Pancreatic Section of the Royal Belgian Society of Surgery and the Belgian Group for Endoscopic Surgery (2002) Laparoscopic liver resection for malignant liver tumors: preliminary results of a multicenter European study. Ann Surg 236:90–97PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Chang S, Laurent A, Tayar C, Karoui M, Cherqui D (2007) Laparoscopy as a routine approach for left lateral sectionectomy. Br J Surg 94:58–63PubMedCrossRefGoogle Scholar
  7. 7.
    Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I et al (2009) The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg 250:825–830PubMedCrossRefGoogle Scholar
  8. 8.
    Dagher I, O’Rourke N, Geller DA, Cherqui D, Belli G, Gamblin TC et al (2009) Laparoscopic major hepatectomy: an evolution in standard of care. Ann Surg 250:856–860PubMedCrossRefGoogle Scholar
  9. 9.
    Moorthy K, Munz Y, Dosis A, Hernandez J, Martin S, Bello F, Rockall T, Darzi A (2004) Dexterity enhancement with robotic surgery. Surg Endosc 18:790–795PubMedGoogle Scholar
  10. 10.
    Mucksavage P, Kerbl DC, Lee JY (2011) The da Vinci® Surgical System overcomes innate hand dominance. J Endourol 25:1385–1388PubMedCrossRefGoogle Scholar
  11. 11.
    Maniar HS, Council ML, Prasad SM, Prasad SM, Chu C, Damiano RJ Jr (2005) Comparison of skill training with robotic systems and traditional endoscopy: implications on training and adoption. J Surg Res 125:23–29PubMedCrossRefGoogle Scholar
  12. 12.
    Heemskerk J, van Gemert WG, de Vries J, Greve J, Bouvy ND (2007) Learning curves of robot-assisted laparoscopic surgery compared with conventional laparoscopic surgery: an experimental study evaluating skill acquisition of robot-assisted laparoscopic tasks compared with conventional laparoscopic tasks in inexperienced users. Surg Laparosc Endosc Percutan Tech 17:171–174PubMedCrossRefGoogle Scholar
  13. 13.
    Tsung A, Geller DA, Sukato DC, Sabbaghian S, Tohme S, Steel J, Marsh W, Reddy SK, Bartlett DL (2014) Robotic versus laparoscopic hepatectomy: a matched comparison. Ann Surg 259:549–555Google Scholar
  14. 14.
    Boggi U, Caniglia F, Amorese G (2013) Laparoscopic robot-assisted major hepatectomy. J Hepatobiliary Pancreat Sci 21:3–10PubMedCrossRefGoogle Scholar
  15. 15.
    Vigano L, Laurent A, Tayar C, Tomatis M, Ponti A, Cherqui D (2009) The learning curve in laparoscopic liver resection: improved feasibility and reproducibility. Ann Surg 250:772–782PubMedCrossRefGoogle Scholar
  16. 16.
    Strasberg S, Belghiti J, Clavien P, Gadzijev E, Garden O, Lau W et al (2000) IHPBA Brisbane 2000 terminology of liver anatomy & resections. HPB (Oxford) 2:333–339Google Scholar
  17. 17.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Wittekind C, Compton C, Quirke P, Nagtegaal I, Merkel S, Hermanek P, Sobin LH (2009) A uniform residual tumor (R) classification: Integration of the R classification and the circumferential margin status. Cancer 115:3483–3488PubMedCrossRefGoogle Scholar
  19. 19.
    Huscher CG, Lirici MM, Chiodini S (1998) Laparoscopic liver resections. Semin Laparosc Surg 5:204–210PubMedGoogle Scholar
  20. 20.
    Dagher I, Caillard C, Proske JM, Carloni A, Lainas P, Franco D (2008) Laparoscopic right hepatectomy: original technique and results. J Am Coll Surg 206:756–760PubMedCrossRefGoogle Scholar
  21. 21.
    O’Rourke N, Fielding G (2004) Laparoscopic right hepatectomy: surgical technique. J Gastrointest Surg 8:213–216PubMedCrossRefGoogle Scholar
  22. 22.
    Gayet B, Cavaliere D, Vibert E, Perniceni T, Levard H, Denet C, Christidis C, Blain A, Mal F (2007) Totally laparoscopic right hepatectomy. Am J Surg 194:685–689PubMedCrossRefGoogle Scholar
  23. 23.
    Nguyen KT, Gamblin TC, Geller DA (2009) World review of laparoscopic liver resection-2,804 patients. Ann Surg 250:831–841PubMedCrossRefGoogle Scholar
  24. 24.
    Giulianotti PC, Sbrana F, Coratti A, Bianco FM, Addeo P, Buchs NC, Ayloo SM, Benedetti E (2011) Totally robotic right hepatectomy: surgical technique and outcome. Arch Surg 146:844–850PubMedCrossRefGoogle Scholar
  25. 25.
    Boggi U, Sinori S, De Lio N, Perrone VG, Vistoli F, Belluomini M, Cappelli C, Amorese G, Mosca F (2013) Feasibility of robotic pancreaticoduodenectomy. Br J Surg 100:917–925PubMedCrossRefGoogle Scholar
  26. 26.
    Turchetti G, Palla I, Pierotti F, Cuschieri A (2012) Economic evaluation of da Vinci-assisted robotic surgery: a systematic review. Surg Endosc 26:598–606PubMedCrossRefGoogle Scholar
  27. 27.
    Viganò L, Ferrero A, Amisano M, Russolillo N, Capussotti L (2013) Comparison of laparoscopic and open intraoperative ultrasonography for staging liver tumours. Br J Surg 100:535–542PubMedCrossRefGoogle Scholar
  28. 28.
    Casciola L, Patriti A, Ceccarelli G et al (2011) Robot assisted parenchymal-sparing liver surgery including lesions located in the posterosuperior segments. Surg Endosc 25:3815–3838PubMedCrossRefGoogle Scholar
  29. 29.
    Schneider CM, Peng PD, Taylor RH, Dachs GW 2nd, Hasser CJ, DiMaio SP, Choti MA (2012) Robot-assisted laparoscopic ultrasonography for hepatic surgery. Surgery 151:756–762PubMedCrossRefGoogle Scholar
  30. 30.
    Owen RM, Perez SD, Lytle N, Patel A, Davis SS, Lin E, Sweeney JF (2013) Impact of operative duration on postoperative pulmonary complications in laparoscopic versus open colectomy. Surg Endosc 27:3555–3563PubMedCrossRefGoogle Scholar
  31. 31.
    Evans C, Lim J, Gatzen C, Huang A (2012) Factors influencing laparoscopic colorectal operative duration and its effect on clinical outcome. Surg Laparosc Endosc Percutan Tech 22:437–442PubMedCrossRefGoogle Scholar
  32. 32.
    Procter LD, Davenport DL, Bernard AC, Zwischenberger JB (2010) General surgical operative duration is associated with increased risk-adjusted infectious complication rates and length of hospital stay. J Am Coll Surg 210:60–65PubMedCrossRefGoogle Scholar
  33. 33.
    Lee KF, Cheung YS, Wong J, Chong CC, Wong JS, Lai PB (2012) Randomized clinical trial of open hepatectomy with or without intermittent Pringle manoeuvre. Br J Surg 99:1203–1209PubMedCrossRefGoogle Scholar
  34. 34.
    Hoekstra LT, van Trigt JD, Reiniers MJ, Busch OR, Gouma DJ, van Gulik TM (2012) Vascular occlusion or not during liver resection: the continuing story. Dig. Surg 29:35–42PubMedCrossRefGoogle Scholar
  35. 35.
    Chouillard EK, Gumbs AA, Cherqui D (2010) Vascular clamping in liver surgery: physiology, indications and techniques. Ann Surg Innov Res 4:2PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Ho CM, Wakabayashi G, Nitta H, Takahashi M, Takahara T, Ito N, Hasegawa Y (2013) Total laparoscopic limited anatomical resection for centrally located hepatocellular carcinoma in cirrhotic liver. Surg Endosc 27:1820–1825PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Rau HG, Duessel AP, Wurzbacher S (2008) The use of water-jet dissection in open and laparoscopic liver resection. HPB (Oxford) 10:275–280CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Marcello Giuseppe Spampinato
    • 1
  • Andrea Coratti
    • 2
  • Luigi Bianco
    • 2
  • Fabio Caniglia
    • 3
  • Andrea Laurenzi
    • 4
  • Francesco Puleo
    • 5
  • Giuseppe Maria Ettorre
    • 4
  • Ugo Boggi
    • 3
  1. 1.Department of General and Advanced Minimally Invasive SurgeryHPB Surgical UnitAbano TermeItaly
  2. 2.Department of General and Minimally Invasive SurgeryMisericordia HospitalGrossetoItaly
  3. 3.General Surgery and Transplantation UnitUniversity of PisaPisaItaly
  4. 4.General Surgery and Transplantation UnitSan Camillo HospitalRomeItaly
  5. 5.Department of GastroenterologyErasmus University HospitalBrusselsBelgium

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