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Based on the IWATE criteria: to investigate the influence of different surgical approaches on the perioperative outcomes of hepatectomy

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Abstract

Background

In terms of perioperative outcomes, compared with traditional open surgery and laparoscopic surgery, studies of robotic liver resection have been limited and must be further clarified.

Methods

Clinical data from 465 patients who underwent liver resection were collected in this retrospective study, and the IWATE criteria were used to evaluate the difficulty level of each operation. We compared perioperative outcomes of open, laparoscopic, or robotic approaches for patients with uncomplicated and complex hepatectomy according to different IWATE scores. Among patients with uncomplicated hepatectomy, the median operation time was significantly longer in the robotic liver resection (RLR) group than in the open liver resection (OLR) and laparoscopic liver resection (LLR) groups; however, the RLR group had the shortest hospital stay. There were no significant differences in intraoperative blood loss, conversion rate, total complication rate, or serious complication rate among the three groups.

Results

Among patients with complex hepatectomy, the RLR group had the smallest intraoperative blood loss and shortest mean length of stay. The cases converted to open hepatectomy were lower in the RLR group than in the laparoscopic group, mainly based on the IWATE score of expert hepatectomy. The incidence of general and serious postoperative complications in the RLR group was significantly lower than that in the OLR and LLR groups.

Conclusions

Robotic liver resection is a safe and feasible surgical method that is more advantageous than laparoscopic and open liver resection, especially in complex liver surgery.

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Funding

This work was supported by the National Natural Science Foundation of China (No. 81760435 and No. 82160460), and the Jiangxi Provincial Natural Science Foundation (NO. 20192ACBL21036, No. 20212BAB216054 and No. 20212BAB206052).

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Author notes

  1. Fei Xie and Jin Ge contributed equally to this manuscript.

Authors and Affiliations

  1. Department of General Surgery, Second Affiliated Hospital of Nanchang University, No.1, Minde Road, Nanchang, 330006, China

    Fei Xie, Jin Ge, Weiwei Sheng, Dongdong Wang, Wenjun Liao, Enliang Li, Linquan Wu & Jun Lei

  2. Jiangxi Province Engineering Research Center of Hepatobiliary Disease, Nanchang, China

    Linquan Wu & Jun Lei

Authors
  1. Fei Xie
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  2. Jin Ge
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  3. Weiwei Sheng
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  4. Dongdong Wang
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  5. Wenjun Liao
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  6. Enliang Li
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  7. Linquan Wu
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  8. Jun Lei
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Contributions

FX and JG contributed equally as joint first authors. JL and LW contributed to the conception and design of this study. FX and JG contributed to the drafting of this manuscript. WS, DW, WL, and EL contributed to the data analysis. All the authors contributed to the data collection, interpretation, and revision of this manuscript. All the authors approved the final version of this manuscript.

Corresponding authors

Correspondence to Linquan Wu or Jun Lei.

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Disclosure

Fei Xie, Jin Ge, Weiwei Sheng, Dongdong Wang, Wenjun Liao, Enliang Li, Linquan Wu, and Jun Lei declare that they have no conflict of interest or financial ties to disclose.

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Xie, F., Ge, J., Sheng, W. et al. Based on the IWATE criteria: to investigate the influence of different surgical approaches on the perioperative outcomes of hepatectomy. Surg Endosc 37, 1044–1052 (2023). https://doi.org/10.1007/s00464-022-09563-6

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  • DOI: https://doi.org/10.1007/s00464-022-09563-6

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