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Minimally invasive liver resection in the era of robotics: analysis of 214 cases

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Abstract

Background

Minimally Invasive Liver Resection (MILR) techniques range from a hybrid-technique to full robotic approaches. When compared with open techniques, MILR has been shown to be advantageous by reducing pain, complications, length of stay and blood loss. The aim of this study was to compare clinical outcomes and hospital resource utilization between full laparoscopic, hand-assisted, and robotic liver resections among major (≥ 3 segments) and minor (≤ 2 segments) resections.

Methods

A single-center comparative retrospective review was completed on 214 patients undergoing full laparoscopic, hand-assisted, or robotic liver resection procedures between 2005 and 2018.

Results

Among minor resections: 85 full laparoscopic, 40 hand-assisted, and 35 robotic liver resection cases were analyzed; and among major resections: 13, 33, and 8 cases were analyzed, respectively. In the adjusted subgroup analysis of minor resections, OR time was significantly longer for the minor hand-assisted group (\( \bar{x} \) = 181 min; p < 0.05), and the average lesion size was smaller for the minor full laparoscopic group (\( \bar{x} \) = 4.2 cm; p < 0.05). Overall, direct hospital charges were lowest in the group of patients who underwent a minor resection using the full laparoscopic technique (\( \bar{x} \) = $39,054.90; p < 0.05), compared to the robotic technique. Due to the smaller sample size (n = 54) in the major resection subgroup, only two significant observations were made - the full laparoscopic group had the least amount of blood loss (\( \bar{x} \) = 227 cc; p < 0.05) and incurred the least amount of room and board charges compared to the other two techniques.

Conclusions

The robotic approach appears favorable for minor resections as evidenced by shorter length of stay but more costly than full laparoscopy. Clinical outcomes appear to be more dependent upon the magnitude of the resection (i.e. major vs. minor) than the MILR technique chosen. Randomized trials may be indicated to discern the best indications and advantages of each technique.

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Authors and Affiliations

  1. The Liver Institute, Methodist Dallas Medical Center, 1411 Beckley Avenue, Suite 268, Dallas, TX, 75203, USA

    Alejandro Mejia & Stephen S. Cheng

  2. Methodist Digestive Institute, Methodist Dallas Medical Center, Dallas, TX, USA

    Elaina Vivian, Jimmy Shah & Hellen Oduor

  3. Clinical Research Institute, Methodist Health System, Dallas, TX, USA

    Priyanka Archarya

Authors
  1. Alejandro Mejia
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  2. Stephen S. Cheng
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  3. Elaina Vivian
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  4. Jimmy Shah
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  5. Hellen Oduor
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  6. Priyanka Archarya
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Corresponding author

Correspondence to Alejandro Mejia.

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Disclosures

Author Alejandro Mejia participates in an Institutional Agreement with Intuitive Surgical as a Proctor and case observations for surgeons. Dr. Stephen Cheng, Mrs. Elaina Vivian, Mr. Jimmy Shah, Mrs. Hellen Oduor, and Mrs. Priyanka Archarya have no conflicts of interest or financial ties to disclose.

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Mejia, A., Cheng, S.S., Vivian, E. et al. Minimally invasive liver resection in the era of robotics: analysis of 214 cases. Surg Endosc 34, 339–348 (2020). https://doi.org/10.1007/s00464-019-06773-3

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  • DOI: https://doi.org/10.1007/s00464-019-06773-3

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