Abstract
Background
Minor liver resections of posterosuperior segments (1, 4A, 7, 8) are challenging to perform laparoscopically and are mainly performed using an open approach. We determined the feasibility of robotic resections of posterosuperior segments and compared short-term outcomes with the open approach.
Methods
Data on open and robotic minor (≤ 3 segments) liver resections including the posterosuperior segments, performed between 2009 and 2016, were collected retrospectively from four hospitals. Robotic and open liver resections were compared, before and after propensity score matching.
Results
In total, 51 robotic and 145 open resections were included. After matching, 31 robotic resections were compared with 31 open resections. Median hospital stay was 4 days (interquartile range [IQR] 3–7) for the robotic group, versus 8 days (IQR 6–10) for the open group (p < 0.001). Median operative time was 222 min (IQR 164–505) for robotic cases versus 231 min (IQR 190–301) for open cases (p = 0.668). Median estimated blood loss was 200 mL (IQR 100–400) versus 300 mL (IQR 125–750), respectively (p = 0.212). In the robotic group, one patient (3%) had a major complication, versus three patients (10%) in the open group (p = 0.612). Readmissions were similar—10% in the robotic group versus 6% in the open group (p > 0.99). There was no mortality in either group.
Conclusion
Minor robotic liver resections of the posterosuperior segments are safe and feasible and display a shorter length of stay than open resections in selected patients at expert centers.
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Acknowledgments
The authors thank F.J. Smits, MD, Department of Surgery, University Medical Center Utrecht, The Netherlands, and R. Nelson, Ph.D., Department of Information Sciences, City of Hope National Medical Center, Duarte, CA, USA, for support during statistical analyses. The authors thank I.M. Newman, Ph.D., Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA, for scientific editing.
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Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under award number P30CA033572. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Conflict of interest
Yanghee Woo is a consultant for Ethicon and Verb Surgical. Yuman Fong is a scientific consultant to Medtronics Inc. Carolijn L. Nota, Mustafa Raoof, Thomas Boerner, I. Quintus Molenaar, Gi Hong Choi, T. Peter Kingham, Karen Latorre, Inne H. M. Borel Rinkes and Jeroen Hagendoorn have declared no conflicts of interest.
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Nota, C.L., Woo, Y., Raoof, M. et al. Robotic Versus Open Minor Liver Resections of the Posterosuperior Segments: A Multinational, Propensity Score-Matched Study. Ann Surg Oncol 26, 583–590 (2019). https://doi.org/10.1245/s10434-018-6928-1
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DOI: https://doi.org/10.1245/s10434-018-6928-1