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

Surgical Endoscopy volume 28, pages 2973–2979 (2014)Cite this 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.

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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.

Author information

Affiliations

  1. Department of General and Advanced Minimally Invasive Surgery, HPB Surgical Unit, Policlinico Abano Terme, piazza C. Colombo 1, 35031, Abano Terme, PD, Italy

    Marcello Giuseppe Spampinato

  2. Department of General and Minimally Invasive Surgery, Misericordia Hospital, Grosseto, Italy

    Andrea Coratti & Luigi Bianco

  3. General Surgery and Transplantation Unit, University of Pisa, Pisa, Italy

    Fabio Caniglia & Ugo Boggi

  4. General Surgery and Transplantation Unit, San Camillo Hospital, Rome, Italy

    Andrea Laurenzi & Giuseppe Maria Ettorre

  5. Department of Gastroenterology, Erasmus University Hospital, Brussels, Belgium

    Francesco Puleo

Authors
  1. Marcello Giuseppe Spampinato
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  2. Andrea Coratti
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  3. Luigi Bianco
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  4. Fabio Caniglia
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  5. Andrea Laurenzi
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  6. Francesco Puleo
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  7. Giuseppe Maria Ettorre
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  8. Ugo Boggi
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Corresponding author

Correspondence to Marcello Giuseppe Spampinato.

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Spampinato, M.G., Coratti, A., Bianco, L. et al. Perioperative outcomes of laparoscopic and robot-assisted major hepatectomies: an Italian multi-institutional comparative study. Surg Endosc 28, 2973–2979 (2014). https://doi.org/10.1007/s00464-014-3560-4

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  • DOI: https://doi.org/10.1007/s00464-014-3560-4

Keywords

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