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Major hepatectomy in elderly patients: possible benefit from robotic platform utilization

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Abstract

Introduction

Robotic surgery has been increasingly utilized, yet its application for hepato–pancreato–biliary (HPB) procedures remains low due to technical complexity, perceived financial burden, and unproven clinical benefits. We hypothesized that the robotic approach would be associated with improved clinical outcomes following major hepatectomy compared with the laparoscopic approach among elderly patients who would benefit from the advantages of minimally invasive surgery.

Methods

A retrospective review of consecutive patients who underwent major hepatectomy between January 2010 and December 2021 at Carolinas Medical Center was performed. Inclusion criteria were age ≥ 65 years and major hepatectomy of three segments or more. Patients who underwent multiple liver resections, vascular/biliary reconstruction, or concomitant extrahepatic procedures (except cholecystectomy) were excluded. Categorical variables were compared using Chi-square or Fisher’s exact test when more than 20% of cells had expected frequencies less than five, and Wilcoxon two-sample or Kruskal–Wallis tests were used for continuous or ordinal variables. Results are described as median and interquartile range (IQR). Multivariate analyses were used on postoperative admission days.

Results

There were 399 major hepatectomies performed during this time period, of which 125 met the criteria and were included. There were no differences in perioperative demographics among patients who underwent robotic hepatectomy (RH, n = 39) and laparoscopic hepatectomy (LH, n = 32). There was no difference in operative time, blood loss, or major complication rates. However, RH had lower rates of conversion to an open procedure (2.6% versus 31.3%, p = 0.002), shorter length of hospital stay [LOS, 4 (3–7) versus 6 (4–8.5) days, p ≤ 0.0001], cumulative LOS [4 (3–7) versus 6 (4.5–9) days, p ≤ 0.0001], and lower rates of intensive care unit (ICU) admission (7.7% versus 75%, p ≤ 0.001), with a trend toward fewer rehabilitation requirements.

Conclusions

Robot major hepatectomy shows clinical advantages in elderly patients, including shorter hospital and ICU stays. These advantages, as well as reduced rehabilitation requirements associated with minimally invasive surgery, could overcome the current perceived financial disadvantages of robotic hepatectomy.

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Authors and Affiliations

  1. Division of HPB Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA

    Osamu Yoshino, Frances McCarron, Benjamin Motz, Erin Baker, David Iannitti, John B. Martinie & Dionisios Vrochides

  2. Department of Surgery, McGill University, Montreal, QC, Canada

    Yifan Wang

  3. Division of Research, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA

    Huaping Wang

  4. Division of HPB and Transplant Surgery, Department of Surgery, Austin Hospital, Victoria, Australia

    Osamu Yoshino

Authors
  1. Osamu Yoshino
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  2. Yifan Wang
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  3. Frances McCarron
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  4. Benjamin Motz
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  5. Huaping Wang
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  6. Erin Baker
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  8. John B. Martinie
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  9. Dionisios Vrochides
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Contributions

Each author made substantial contributions to the design of the study, interpretation of data, and drafting and substantive revision of the manuscript and multimedia contents.

Corresponding author

Correspondence to Osamu Yoshino.

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Disclosure

Dr. John. B. Martinie reports grants, personal fees, and nonfinancial support from Intuitive Surgical, outside the submitted work. Dr Osamu Yoshino’s fellowship salary is granted by Intuitive. Dr. Dionisios Vrochides, Dr Yifan Wang, Dr Benjamin Motz, Dr Frances McCarron, Dr Huaping Wang Dr Erin Baker, and Dr David Iannitti have nothing to disclose.

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Yoshino, O., Wang, Y., McCarron, F. et al. Major hepatectomy in elderly patients: possible benefit from robotic platform utilization. Surg Endosc 37, 6228–6234 (2023). https://doi.org/10.1007/s00464-023-10062-5

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  • DOI: https://doi.org/10.1007/s00464-023-10062-5

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