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Robotic versus laparoscopic liver resections for hepatolithiasis: an international multicenter propensity score matched analysis

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Abstract

Introduction

Minimally invasive liver resection (MILR) is widely recognized as a safe and beneficial procedure in the treatment of both malignant and benign liver diseases. Hepatolithiasis has traditionally been reported to be endemic only in East Asia, but has seen a worldwide uptrend in recent decades with increasingly frequent and invasive endoscopic instrumentation of the biliary tract for a myriad of conditions. To date, there has been a woeful lack of high-quality evidence comparing the laparoscopic (LLR) and robotic (RLR) approaches to treatment hepatolithiasis.

Methods

This is an international multicenter retrospective analysis of 273 patients who underwent RLR or LRR for hepatolithiasis at 33 centers in 2003–2020. The baseline clinicopathological characteristics and perioperative outcomes of these patients were assessed. To minimize selection bias, 1:1 (48 and 48 cases of RLR and LLR, respectively) and 1:2 (37 and 74 cases of RLR and LLR, respectively) propensity score matching (PSM) was performed.

Results

In the unmatched cohort, 63 (23.1%) patients underwent RLR, and 210 (76.9%) patients underwent LLR. Patient clinicopathological characteristics were comparable between the groups after PSM. After 1:1 and 1:2 PSM, RLR was associated with less blood loss (p = 0.003 in 1:2 PSM; p = 0.005 in 1:1 PSM), less patients with blood loss greater than 300 ml (p = 0.024 in 1:2 PSM; p = 0.027 in 1:1 PSM), and lower conversion rate to open surgery (p = 0.003 in 1:2 PSM; p < 0.001 in 1:1 PSM). There was no significant difference between RLR and LLR in use of the Pringle maneuver, median Pringle maneuver duration, 30-day readmission rate, postoperative morbidity, major morbidity, reoperation, and mortality.

Conclusion

Both RLR and LLR were safe and feasible for hepatolithiasis. RLR was associated with significantly less blood loss and lower open conversion rate.

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Acknowledgements

International robotic and laparoscopic liver resection study group investigators: Chung-Yip Chan (Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital/ National Cancer Centre Singapore, Singapore); Juul Meurs (Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium); Celine De Meyere (Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium); Eric C. H. Lai (Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China); Felix Krenzien (Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, and Berlin Institute of Health, Berlin, Germany); Moritz Schmelzle (Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, and Berlin Institute of Health, Berlin, Germany); Prashant Kadam (Department of Hepatopancreatobiliary and Liver Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom); Roberto Montalti (Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, Federico II University Hospital Naples, Naples, Italy); Mariano Giglio (Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, Federico II University Hospital Naples, Naples, Italy); Kit-Fai Lee (Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China); Diana Salimgereeva (Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia); Ruslan Alikhanov (Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia); Lip Seng Lee (Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital, Singapore); Mikel Gastaca (Hepatobiliary Surgery and Liver Transplantation Unit, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Bilbao, Spain); Jae Young Jang (Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea); Chetana Lim (Department of Digestive, HBP and Liver Transplantation, Hopital Pitie-Salpetriere, Sorbonne Universite, Paris, France; Phan Phuoc Nghia (HPB Surgery Department, University Medical Center, Ho Chi Minh City); Masayuki Kojima (Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan); Yutaro Kato (Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan); Mansour Saleh (Department of Hepatobiliary Surgery, Assistance Publique Hopitaux de Paris, Centre Hepato-Biliaire, Paul-Brousse Hospital, Villejuif, France); Franco Pascual (Department of Hepatobiliary Surgery, Assistance Publique Hopitaux de Paris, Centre Hepato-Biliaire, Paul-Brousse Hospital, Villejuif, France); Fabricio Ferreira Coelho (Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil); Jaime Arthur Pirola Kruger (Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil); Astmund Avdem Fretland (The Intervention Centre and Department of HPB Surgery, Oslo University Hospital, Oslo University, Oslo, Norway); Jacob Ghotbi (The Intervention Centre and Department of HPB Surgery, Oslo University Hospital, Oslo University, Oslo, Norway); Bernardo Dalla Valle (General and Hepatobiliary Surgery, Department of Surgery, Dentistry, Gynecology and Pediatrics, University of Verona, GB Rossi Hospital, Verona, Italy); Yoelimar Guzmán (General & Digestive Surgery, Hospital Clínic, Barcelona, Spain)

Funding

Dr T. P. Kingham was partially supported by the US National Cancer Institute MSKCC Core Grant number P30 CA008747 for this study.

Author information

Author notes

  1. Bong Jun Kwak, Jae Hoon Lee are co-first authors who contributed equally to the manuscript.

Authors and Affiliations

  1. Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Bong Jun Kwak & Jae Hoon Lee

  2. Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore

    Ken Min Chin

  3. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Nicholas L. Syn

  4. Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea

    Sung Hoon Choi

  5. Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, People’s Republic of China

    Tan To Cheung

  6. Department of Surgery, Hepatopancreatobiliary Unit, Changi General Hospital, Singapore, Singapore

    Adrian K. H. Chiow

  7. AdventHealth Tampa, Digestive Health Institute, Tampa, FL, USA

    Iswanto Sucandy

  8. General Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy

    Marco V. Marino

  9. Hepatobiliary Surgery and Liver Transplantation Unit, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Bilbao, Spain

    Mikel Prieto

  10. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, People’s Republic of China

    Charing C. Chong

  11. Division of Hepatopancreatobiliary Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

    Gi Hong Choi

  12. Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia

    Mikhail Efanov

  13. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    T. Peter Kingham

  14. Department of Hepatopancreatobiliary and Liver Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

    Robert P. Sutcliffe

  15. Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, Federico II University Hospital Naples, Naples, Federico, Italy

    Roberto I. Troisi

  16. Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, and Berlin Institute of Health, Berlin, Germany

    Johann Pratschke

  17. Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China

    Xiaoying Wang

  18. Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium

    Mathieu D’Hondt

  19. Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, People’s Republic of China

    Chung Ngai Tang

  20. Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan

    Kohei Mishima & Go Wakabayashi

  21. Department of Hepatobiliary Surgery, Assistance Publique Hopitaux de Paris, Paul-Brousse Hospital, Centre Hepato-Biliaire, Villejuif, France

    Daniel Cherqui

  22. The Intervention Centre and Department of Hepatic, Pancreatic and Biliary Surgery, Oslo University Hospital and Institute of Clinical Medicine, Oslo University, Oslo, Norway

    Davit L. Aghayan & Bjorn Edwin

  23. Department of Digestive, HBP and Liver Transplantation, Hopital Pitie-Salpetriere, APHP, Sorbonne Université, Paris, France

    Olivier Scatton

  24. Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan

    Atsushi Sugioka

  25. Department of Hepatopancreatobiliary Surgery, University Medical Center, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam

    Tran Cong Duy Long

  26. General and Digestive Surgery, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain

    Constantino Fondevila

  27. Department of Surgery, University Hospital Southampton, Southampton, UK

    Mohammad Alzoubi & Mohammad Abu Hilal

  28. General and Hepatobiliary Surgery, Department of Surgery, Dentistry, Gynecology and Pediatrics, University of Verona, GB Rossi Hospital, Verona, Italy

    Andrea Ruzzenente

  29. Department of General and Oncological Surgery, Mauriziano Hospital, Turin, Italy

    Alessandro Ferrero

  30. Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil

    Paulo Herman

  31. Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea

    Boram Lee & Ho-Seong Han

  32. Department of Digestive, Oncologic and Metabolic Surgery, Institute Mutualiste Montsouris, Universite Paris Descartes, Paris, France

    David Fuks

  33. Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy

    Federica Cipriani & Luca Aldrighetti

  34. Faculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, People’s Republic of China

    Qu Liu & Rong Liu

  35. Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, National Cancer Centre Singapore and Duke-National University Singapore Medical School, Academia, Level 5, 20 College Road, Singapore, 169856, Singapore

    Brian K. P. Goh

  36. Oncologic Surgery Department, P. Giaccone University Hospital, Palermo, Italy

    Marco V. Marino

  37. Department of Surgery, Fondazione Poliambulanza, Brescia, Italy

    Mohammad Abu Hilal

  38. General and Digestive Surgery, Hospital Universitario La Paz, IdiPAZ, CIBERehd, Madrid, Spain

    Constantino Fondevila

Authors
  1. Bong Jun Kwak
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  2. Jae Hoon Lee
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  3. Ken Min Chin
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  4. Nicholas L. Syn
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  5. Sung Hoon Choi
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  6. Tan To Cheung
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  7. Adrian K. H. Chiow
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  8. Iswanto Sucandy
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  9. Marco V. Marino
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  10. Mikel Prieto
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  11. Charing C. Chong
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  12. Gi Hong Choi
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  13. Mikhail Efanov
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  14. T. Peter Kingham
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  15. Robert P. Sutcliffe
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  16. Roberto I. Troisi
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  17. Johann Pratschke
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  18. Xiaoying Wang
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  19. Mathieu D’Hondt
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  20. Chung Ngai Tang
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  21. Kohei Mishima
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  22. Go Wakabayashi
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  23. Daniel Cherqui
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  25. Bjorn Edwin
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  27. Atsushi Sugioka
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  28. Tran Cong Duy Long
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  29. Constantino Fondevila
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  30. Mohammad Alzoubi
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  31. Mohammad Abu Hilal
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  32. Andrea Ruzzenente
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  33. Alessandro Ferrero
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  34. Paulo Herman
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  35. Boram Lee
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  36. David Fuks
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  37. Federica Cipriani
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  38. Qu Liu
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  39. Luca Aldrighetti
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  40. Rong Liu
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  41. Ho-Seong Han
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  42. Brian K. P. Goh
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Consortia

International robotic and laparoscopic liver resection study group investigators

  • Chung-Yip Chan
  • , Juul Meurs
  • , Celine De Meyere
  • , Eric C. H. Lai
  • , Felix Krenzien
  • , Moritz Schmelzle
  • , Prashant Kadam
  • , Roberto Montalti
  • , Mariano Giglio
  • , Kit-Fai Lee
  • , Diana Salimgereeva
  • , Ruslan Alikhanov
  • , Lip Seng Lee
  • , Mikel Gastaca
  • , Jae Young Jang
  • , Chetana Lim
  • , Phan Phuoc Nghia
  • , Masayuki Kojima
  • , Yutaro Kato
  • , Mansour Saleh
  • , Franco Pascual
  • , Fabricio Ferreira Coelho
  • , Jaime Arthur Pirola Kruger
  • , Astmund Avdem Fretland
  • , Jacob Ghotbi
  • , Bernardo Dalla Valle
  •  & Yoelimar Guzmán

Corresponding author

Correspondence to Brian K. P. Goh.

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Dr Goh BK has received travel grants and honorarium from Johnson & Johnson, Olympus and Transmedic, the local distributor for the Da Vinci Robot. Dr Marino MV is a consultant for CAVA Robotics LLC. Johann Pratschke reports receiving a research grant from Intuitive Surgical Deutschland GmbH and personal fees or non-financial support from Johnson & Johnson, Medtronic, AFS Medical, Astellas, CHG Meridian, Chiesi, Falk Foundation, La Fource Group, Merck, Neovii, NOGGO, Peterson, and Promedicis. Moritz Schmelzle reports receiving personal fees or other support outside of the submitted work from Merck, Bayer, ERBE, Amgen, Johnson & Johnson, Takeda, Olympus, and Medtronic. Asmund Fretland reports receiving speaker fees from Bayer. Bong Jun Kwak, Jae Hoon Lee, Ken-Min Chin, Nicholas L. Syn, Sung Hoon Choi, Tan-To Cheung, Adrian K. H. Chiow, Iswanto Sucandy, Mikel Prieto, Charing C. Chong, Gi-Hong Choi, Mikhail Efanov, T. Peter Kingham, Robert P. Sutcliffe, Roberto I. Troisi, Xiaoying Wang, Mathieu D’Hondt, Chung Ngai Tang, Kohei Mishima, Go Wakabayashi, Daniel Cherqui, Davit L. Aghayan, Bjorn Edwin, Olivier Scatton, Atsushi Sugioka, Tran Cong Duy Long, Constantino Fondevila, Mohammad Alzoubi, Mohammad Abu Hilal, Andrea Ruzzenente, Alessandro Ferrero, Paulo Herman, Boram Lee, David Fuks. Federica Cipriani, Qu Liu, Luca Aldrighetti, Rong Liu and Ho-Seong Han have no conflicts of interest or financial ties to disclose.

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Kwak, B.J., Lee, J.H., Chin, K.M. et al. Robotic versus laparoscopic liver resections for hepatolithiasis: an international multicenter propensity score matched analysis. Surg Endosc 37, 5855–5864 (2023). https://doi.org/10.1007/s00464-023-10051-8

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