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Robotic Versus Laparoscopic Hepatectomy: A Single Surgeon Experience of 629 Consecutive Minimally Invasive Liver Resections

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Abstract

Background

Robotic surgery has the potential to broaden the indications for minimally invasive liver surgery owing to its technical advantages. This paper compares our experience with robotic liver surgery (RLS) with conventional laparoscopic liver surgery (LLS).

Methods

All consecutive liver resections between October 2011 and October 2022 were selected from our prospective database to be included in this cohort study. Patients who underwent RLS were compared with a LLS group for operative and postoperative outcomes.

Results

In total, 629 patients were selected from our database, including 177 patients who underwent a RLS and 452 patients who had LLS. Colorectal liver metastasis was the main indication for surgery in both groups. With the introduction of RLS, the percentage of open resections decreased significantly (32.6% from 2011 to 2020 vs. 11.5% from 2020 onward, P < 0.001). In the robotic group, redo liver surgery was more frequent (24.3% vs. 16.8%, P = 0.031) and the Southampton difficulty score was higher (4 [IQR 4 to 7] vs. 4 [IQR 3 to 6], P = 0.02). Median blood loss was lower (30 vs. 100 ml, P < 0.001), and postoperative length of stay (LOS) was shorter in the robotic group (median 3 vs. 4 days, P < 0.001). There was no significant difference in postoperative complications. Cost related to the used instruments and LOS was significantly lower in the RLS group (median €1483 vs. €1796, P < 0.001 and €1218 vs. €1624, P < 0.001, respectively), while cost related to operative time was higher (median €2755 vs. €2470, P < 0.001).

Conclusions

RLS may allow for a higher percentage of liver resections to be completed in a minimally invasive way with lower blood loss and a shorter LOS.

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Funding

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Authors and Affiliations

  1. Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium

    Thomas Winckelmans, Isabelle Parmentier, Celine De Meyere, Chris Verslype & Mathieu D’Hondt

  2. Department of Abdominal and Hepatobiliary/Pancreatic Surgery, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium

    Dennis A. Wicherts & Chris Verslype

  3. Department of Oncology and Statistics, Groeninge Hospital, President Kennedylaan 4, Kortrijk, België

    Isabelle Parmentier

  4. Department of Gastroenterology and Hepatology, KU Leuven, Leuven, Belgium

    Chris Verslype

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  1. Thomas Winckelmans
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  4. Celine De Meyere
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Correspondence to Mathieu D’Hondt.

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Winckelmans, T., Wicherts, D.A., Parmentier, I. et al. Robotic Versus Laparoscopic Hepatectomy: A Single Surgeon Experience of 629 Consecutive Minimally Invasive Liver Resections. World J Surg 47, 2241–2249 (2023). https://doi.org/10.1007/s00268-023-07060-y

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