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Minimally Invasive Hepatectomy in North America: Laparoscopic Versus Robotic

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Minimally invasive hepatectomy has been shown to be associated with improved outcomes when compared with open surgery. However, data comparing laparoscopic and robotic hepatectomy is lacking and limited to single-center studies.

Methods

Patients undergoing major (≥ 3 segments) or partial (≤ 2 segments) hepatectomy were identified in the 2014–2017 ACS-NSQIP hepatectomy targeted database. Patients undergoing laparoscopic and robotic approaches were compared, and propensity score matching was utilized to adjust for bias.

Results

Of 3152 minimally invasive hepatectomies (MIHs), 86% (N = 2706) were partial and 14% (N = 446) were major. The laparoscopic approach was utilized in 92% of patients (N = 2905) and 8% were performed robotically (N = 247). The percentage of MIHs increased over time (p < 0.01). After matching, 240 were identified in each cohort. Compared with the robotic approach, patients undergoing laparoscopic hepatectomy had a significantly higher conversion rate (23% vs. 7.4%) but had shorter operative time (159 vs. 204 min) (p < 0.001). Laparoscopic cases undergoing an unplanned conversion to open were associated with increased morbidity (p < 0.001), but this difference was not observed in robotic cases. Both MIH approaches had low mortality (1.0%, p = 1.00), overall morbidity (17%, p = 0.47), and very short length of stay (3 days, p = 0.80).

Conclusion

Minimally invasive hepatectomy is performed primarily for partial hepatectomies. Laparoscopic hepatectomy is associated with a significantly higher conversion rate, and converted cases have worse outcomes. Both minimally invasive approaches are safe with similar mortality, morbidity, and a very short length of stay.

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Acknowledgments

The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS-NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors. We would like to acknowledge the Surgical Clinical Reviewers and the American College of Surgeons for their tireless efforts at maintaining the National Surgical Quality Improvement Project.

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Authors and Affiliations

  1. Department of Surgery, Lewis Katz School of Medicine at Temple University, 3401 N Broad Street, Philadelphia, PA, 19140, USA

    Alexander M. Fagenson, Henry A. Pitt & Kwan N. Lau

  2. Department of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1259, New York, NY, 10029, USA

    Elizabeth M. Gleeson

Authors
  1. Alexander M. Fagenson
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  2. Elizabeth M. Gleeson
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  3. Henry A. Pitt
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  4. Kwan N. Lau
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Contributions

Design of the work: AMF, HAP, KNL

Analysis and interpretation of data for the work: AMF, EMG, HAP, KNL

Drafting of the work: AMF

Critical revision: AMF, EMG HAP, KNL

Final approval of the version to be published: AMF, EMG, HAP, KNL

Agreement to be accountable for all aspects of the work in ensuring that all questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: all authors

Corresponding author

Correspondence to Kwan N. Lau.

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The authors declare that they have no conflict of interest.

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This work was accepted for a Quickshot presentation at the 61st Annual Meeting of the Society for Surgery of the Alimentary Tract during Digestive Disease Week in Chicago, IL 2020.

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Fagenson, A.M., Gleeson, E.M., Pitt, H.A. et al. Minimally Invasive Hepatectomy in North America: Laparoscopic Versus Robotic. J Gastrointest Surg 25, 85–93 (2021). https://doi.org/10.1007/s11605-020-04703-6

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  • DOI: https://doi.org/10.1007/s11605-020-04703-6

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