Skip to main content
SpringerLink
Log in

Economic analysis of open versus laparoscopic versus robotic hepatectomy: a systematic review and meta-analysis

  • Original Paper
  • Published:
The European Journal of Health Economics Aims and scope Submit manuscript

Abstract

Background

Following the publication of reports from landmark international consensuses (Louisville 2008 and Morioka 2014), minimally invasive hepatectomy became widely accepted as a legitimate alternative to open surgery. We aimed to compare the operative, hospitalization, and total economic costs of open (OLR) vs. laparoscopic (LLR) vs. robotic liver resection (RLR).

Methods

We performed a systematic literature review (end-of-search date: July 3, 2020) according to the PRISMA statement. Random-effects meta-analyses were conducted. Quality assessment was performed with the Cochrane Risk of Bias tool for randomized controlled trials, and the Newcastle–Ottawa Scale for non-randomized studies.

Results

Thirty-eight studies reporting on 3847 patients (1783 OLR; 1674 LLR; 390 RLR) were included. The operative costs of LLR were significantly higher than those of OLR, while subgroup analysis also showed higher operative costs in the LLR group for major hepatectomy, but no statistically significant difference for minor hepatectomy. Hospitalization costs were significantly lower in the LLR group, with subgroup analyses indicating lower costs for LLR in both major and minor hepatectomy series. No statistically significant difference was observed regarding total costs between LLR and OLR both overall and on subgroup analyses in either major or minor hepatectomy series. Meta-analyses showed higher operative, hospitalization, and total costs for RLR vs. LLR, but no statistically significant difference regarding total costs for RLR vs. OLR.

Conclusion

LLR’s higher operative costs are offset by lower hospitalization costs compared to OLR leading to no statistically significant difference in total costs, while RLR appears to be a more expensive alternative approach.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Nguyen, K.T., Gamblin, T.C., Geller, D.A.: World review of laparoscopic liver resection-2,804 patients. Ann. Surg. 250, 831–841 (2009). https://doi.org/10.1097/SLA.0b013e3181b0c4df

    Article  PubMed  Google Scholar 

  2. Cai, X.J., Yang, J., Yu, H., Liang, X., Wang, Y.F., Zhu, Z.Y., Peng, S.Y.: Clinical study of laparoscopic versus open hepatectomy for malignant liver tumors. Surg. Endosc. 22, 2350–2356 (2008). https://doi.org/10.1007/s00464-008-9789-z

    Article  PubMed  Google Scholar 

  3. Shin, Y.C., Jang, J.-Y., Kang, M.J., Jung, W., Chang, J., Chang, Y.R., Kim, S.-W.: Comparison of laparoscopic versus open left-sided hepatectomy for intrahepatic duct stones. Surg. Endosc. 30, 259–265 (2016). https://doi.org/10.1007/s00464-015-4200-3

    Article  PubMed  Google Scholar 

  4. Buell, J.F., Cherqui, D., Geller, D.A., O’Rourke, N., Iannitti, D., Dagher, I., Koffron, A.J., Thomas, M., Gayet, B., Han, H.S., Wakabayashi, G., Belli, G., Kaneko, H., Ker, C.G., Scatton, O., Laurent, A., Abdalla, E.K., Chaudhury, P., Dutson, E., Gamblin, C., D’Angelica, M., Nagorney, D., Testa, G., Labow, D., Manas, D., Poon, R.T., Nelson, H., Martin, R., Clary, B., Pinson, W.C., Martinie, J., Vauthey, J.N., Goldstein, R., Roayaie, S., Barlet, D., Espat, J., Abecassis, M., Rees, M., Fong, Y., McMasters, K.M., Broelsch, C., Busuttil, R., Belghiti, J., Strasberg, S., Chari, R.S.: Position on laparoscopic liver surgery. Ann. Surg. 250, 825–830 (2009). https://doi.org/10.1097/SLA.0b013e3181b3b2d8

    Article  PubMed  Google Scholar 

  5. Wakabayashi, G., Cherqui, D., Geller, D.A., Buell, J.F., Kaneko, H., Han, H.S., Asbun, H., Orourke, N., Tanabe, M., Koffron, A.J., Tsung, A., Soubrane, O., Machado, M.A., Gayet, B., Troisi, R.I., Pessaux, P., Van Dam, R.M., Scatton, O., Abu Hilal, M., Belli, G., Kwon, C.H.D., Edwin, B., Choi, G.H., Aldrighetti, L.A., Cai, X., Cleary, S., Chen, K.-H., Schon, M.R., Sugioka, A., Tang, C.-N., Herman, P., Pekolj, J., Chen, X.-P., Dagher, I., Jarnagin, W., Yamamoto, M., Strong, R., Jagannath, P., Lo, C.-M., Clavien, P.-A., Kokudo, N., Barkun, J., Strasberg, S.M.: Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann. Surg. 261, 619–629 (2015). https://doi.org/10.1097/SLA.0000000000001184

    Article  PubMed  Google Scholar 

  6. Mirnezami, R., Mirnezami, A.H., Chandrakumaran, K., Abu Hilal, M., Pearce, N.W., Primrose, J.N., Sutcliffe, R.P.: Short- and long-term outcomes after laparoscopic and open hepatic resection: Systematic review and meta-analysis. HPB (2011). https://doi.org/10.1111/j.1477-2574.2011.00295.x

    Article  PubMed  PubMed Central  Google Scholar 

  7. Xiong, J.-J., Altaf, K., Javed, M.A., Huang, W., Mukherjee, R., Mai, G., Sutton, R., Liu, X.-B., Hu, W.-M.: Meta-analysis of laparoscopic vs open liver resection for hepatocellular carcinoma. World J. Gastroenterol. 18, 6657–6668 (2012). https://doi.org/10.3748/wjg.v18.i45.6657

    Article  PubMed  PubMed Central  Google Scholar 

  8. Liu, Z., Ding, H., Xiong, X., Huang, Y.: Laparoscopic left lateral hepatic sectionectomy was expected to be the standard for the treatment of left hepatic lobe lesions: A meta-analysis. Medicine (Baltimore) 97, 9835 (2018). https://doi.org/10.1097/MD.0000000000009835

    Article  Google Scholar 

  9. Limongelli, P., Vitiello, C., Belli, A., Pai, M., Tolone, S., Del Genio, G., Brusciano, L., Docimo, G., Habib, N., Belli, G., Jiao, L.R., Docimo, L.: Costs of laparoscopic and open liver and pancreatic resection: a systematic review. World J. Gastroenterol. 20, 17595–17602 (2014). https://doi.org/10.3748/wjg.v20.i46.17595

    Article  PubMed  PubMed Central  Google Scholar 

  10. Marescaux, J., Leroy, J., Gagner, M., Rubino, F., Mutter, D., Vix, M., Butner, S.E., Smith, M.K.: Transatlantic robot-assisted telesurgery. Nature 413, 379–380 (2001). https://doi.org/10.1038/35096636

    Article  CAS  PubMed  Google Scholar 

  11. Hanna, T., Imber, C.: Robotics in HPB surgery. Ann. R. Coll. Surg. Engl. 100, 31–37 (2018). https://doi.org/10.1308/rcsann.supp1.31

    Article  PubMed  Google Scholar 

  12. Wong, D.J., Wong, M.J., Choi, G.H., Wu, Y.M., Lai, P.B., Goh, B.K.P.: Systematic review and meta-analysis of robotic versus open hepatectomy. ANZ J. Surg. 89, 165–170 (2019). https://doi.org/10.1111/ans.14690

    Article  PubMed  Google Scholar 

  13. Liberati, A., Altman, D.G., Tetzlaff, J., Mulrow, C., Gotzsche, P.C., Ioannidis, J.P.A., Clarke, M., Devereaux, P.J., Kleijnen, J., Moher, D.: The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: Explanation and elaboration. BMJ 339, b2700 (2009). https://doi.org/10.1136/bmj.b2700

    Article  PubMed  PubMed Central  Google Scholar 

  14. Veritas Health Innovation. Covidence Systematic Review Software. Melbourne, Australia: Veritas Health Innovation, 2018. www.covidence.org. Accessed 3 July 2020

  15. Wohlin, C.: Guidelines for snowballing in systematic literature studies and a replication in software engineering. In: Proceedings of the 18th International Conference on Evaluation and Assessment in Software Engineering, pp. 381–3810. ACM, New York (2014)

    Google Scholar 

  16. Strasberg, S.M.: Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. J. Hepatobiliary Pancreat. Surg. 12, 351–355 (2005). https://doi.org/10.1007/s00534-005-0999-7

    Article  PubMed  Google Scholar 

  17. Hozo, S.P., Djulbegovic, B., Hozo, I.: Estimating the mean and variance from the median, range, and the size of a sample. BMC Med. Res. Methodol. 5, 13 (2005). https://doi.org/10.1186/1471-2288-5-13

    Article  PubMed  PubMed Central  Google Scholar 

  18. Wan, X., Wang, W., Liu, J., Tong, T.: Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med. Res. Methodol. 14, 135 (2014). https://doi.org/10.1186/1471-2288-14-135

    Article  PubMed  PubMed Central  Google Scholar 

  19. Higgins, J.P.T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M.J., Welch, V.A.: Cochrane Handbook for Systematic Reviews of Interventions version 6.1 (updated September 2020). Cochrane (2020) www.training.cochrane.org/handbook. Accessed 1 Dec 2020

  20. Egger, M., Davey Smith, G., Schneider, M., Minder, C.: Bias in meta-analysis detected by a simple, graphical test. BMJ 315, 629–634 (1997)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Higgins, J.P.T., Altman, D.G., Gøtzsche, P.C., Jüni, P., Moher, D., Oxman, A.D., Savovic, J., Schulz, K.F., Weeks, L., Sterne, J.A.C.: The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343, d5928 (2011). https://doi.org/10.1136/bmj.d5928

    Article  PubMed  PubMed Central  Google Scholar 

  22. Stang, A.: Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur. J. Epidemiol. 25, 603–605 (2010). https://doi.org/10.1007/s10654-010-9491-z

    Article  PubMed  Google Scholar 

  23. Guyatt, G.H., Oxman, A.D., Vist, G.E., Kunz, R., Falck-Ytter, Y., Alonso-Coello, P., Schünemann, H.J.: GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336, 924–926 (2008). https://doi.org/10.1136/bmj.39489.470347.AD

    Article  PubMed  PubMed Central  Google Scholar 

  24. Wang, Y., Fang, J., Lin, L., Pan, L., Nan, J., Cui, X., Liu, H., Chen, M., Gu, Q., Cai, X.: Laparoscopic versus open hemihepatectomy: a 1:1 matched analysis. Ann. Transl. Med. 8, 431 (2020). https://doi.org/10.21037/atm.2020.03.188

    Article  PubMed  PubMed Central  Google Scholar 

  25. Mejia, A., Cheng, S.S., Vivian, E., Shah, J., Oduor, H., Archarya, P.: Minimally invasive liver resection in the era of robotics: analysis of 214 cases. Surg. Endosc. 34, 339–348 (2020). https://doi.org/10.1007/s00464-019-06773-3

    Article  PubMed  Google Scholar 

  26. Xu, H.W., Liu, F., Li, H.Y., Wei, Y.G., Li, B.: Outcomes following laparoscopic versus open major hepatectomy for hepatocellular carcinoma in patients with cirrhosis: A propensity score-matched analysis. Surg Endosc 32, 712–719 (2018). https://doi.org/10.1007/s00464-017-5727-2

    Article  PubMed  Google Scholar 

  27. Peng, L., Xiao, J., Liu, Z., Zhu, J., Wan, R., Xiao, W., Li, Y.: Laparoscopic left-sided hepatectomy for the treatment of hepatolithiasis: a comparative study with open approach. Int. J. Surg. 40, 117–123 (2017). https://doi.org/10.1016/j.ijsu.2017.02.068

    Article  PubMed  Google Scholar 

  28. Salloum, C., Lim, C., Lahat, E., Gavara, C.G.I., Levesque, E., Compagnon, P., Azoulay, D.: Robotic-assisted versus laparoscopic left lateral sectionectomy: analysis of surgical outcomes and costs by a propensity score matched cohort study. World J. Surg. 41, 516–524 (2017). https://doi.org/10.1007/s00268-016-3736-2

    Article  PubMed  Google Scholar 

  29. Daskalaki, D., Gonzalez-Heredia, R., Brown, M., Bianco, F.M., Tzvetanov, I., Davis, M., Kim, J., Benedetti, E., Giulianotti, P.C.: Financial impact of the robotic approach in liver surgery: A comparative study of clinical outcomes and costs between the robotic and open technique in a single institution. J. Laparoendosc. Adv. Surg. Tech. 27, 375–382 (2017). https://doi.org/10.1089/lap.2016.0576

    Article  Google Scholar 

  30. Chen, P.-D., Wu, C.-Y., Hu, R.-H., Ho, C.-M., Lee, P.-H., Lai, H.-S., Lin, M.-T., Wu, Y.-M.: Robotic liver donor right hepatectomy: A pure, minimally invasive approach. Liver Transpl. 22, 1509–1518 (2016). https://doi.org/10.1002/lt.24522

    Article  PubMed  Google Scholar 

  31. Kim, J.K., Park, J.S., Han, D.H., Choi, G.H., Kim, K.S., Choi, J.S., Yoon, D.S.: Robotic versus laparoscopic left lateral sectionectomy of liver. Surg. Endosc. 30, 4756–4764 (2016). https://doi.org/10.1007/s00464-016-4803-3

    Article  PubMed  Google Scholar 

  32. Sham, J.G., Richards, M.K., Seo, Y.D., Pillarisetty, V.G., Yeung, R.S., Park, J.O.: Efficacy and cost of robotic hepatectomy: Is the robot cost-prohibitive? J. Robot. Surg. 10, 307–313 (2016). https://doi.org/10.1007/s11701-016-0598-4

    Article  PubMed  Google Scholar 

  33. Kawaguchi, Y., Otsuka, Y., Kaneko, H., Nagai, M., Nomura, Y., Yamamoto, M., Otani, M., Ohashi, Y., Sugawara, K., Koike, D., Ishida, T., Kokudo, N., Tanaka, N.: Comparisons of financial and short-term outcomes between laparoscopic and open hepatectomy: Benefits for patients and hospitals. Surg. Today 46, 535–542 (2016). https://doi.org/10.1007/s00595-015-1189-0

    Article  PubMed  Google Scholar 

  34. Zhang, J., Zhou, Z.-G., Huang, Z.-X., Yang, K.-L., Chen, J.-C., Chen, J.-B., Xu, L., Chen, M.-S., Zhang, Y.-J.: Prospective, single-center cohort study analyzing the efficacy of complete laparoscopic resection on recurrent hepatocellular carcinoma. Chin. J. Cancer. (2016). https://doi.org/10.1186/s40880-016-0088-0

    Article  PubMed  PubMed Central  Google Scholar 

  35. Croner, R.S., Perrakis, A., Hohenberger, W., Brunner, M.: Robotic liver surgery for minor hepatic resections: A comparison with laparoscopic and open standard procedures. Langenbeck’s Arch. Surg. 401, 707–714 (2016). https://doi.org/10.1007/s00423-016-1440-1

    Article  Google Scholar 

  36. Cipriani, F., Ratti, F., Cardella, A., Catena, M., Paganelli, M., Aldrighetti, L.: Laparoscopic versus open major hepatectomy: Analysis of clinical outcomes and cost effectiveness in a high-volume center. J. Gastrointest. Surg. 23, 2163–2173 (2019). https://doi.org/10.1007/s11605-019-04112-4

    Article  PubMed  Google Scholar 

  37. Wang, X.-T., Wang, H.-G., Duan, W.-D., Wu, C.-Y., Chen, M.-Y., Li, H., Huang, X., Zhang, F.-B., Dong, J.-H.: Pure laparoscopic versus open liver resection for primary liver carcinoma in elderly patients: A single-center, case-matched study. Medicine (Baltimore) 94, 1854 (2015). https://doi.org/10.1097/MD.0000000000001854

    Article  Google Scholar 

  38. Jiang, H.T., Cao, J.Y.: Impact of laparoscopic versus open hepatectomy on perioperative clinical outcomes of patients with primary hepatic carcinoma. Chin. Med. Sci. J. 30, 80–83 (2015). https://doi.org/10.1016/S1001-9294(15)30016-X

    Article  PubMed  Google Scholar 

  39. Bell, R., Pandanaboyana, S., Hanif, F., Shah, N., Hidalgo, E., Lodge, J.P.A., Toogood, G., Prasad, K.R.: A cost effective analysis of a laparoscopic versus an open left lateral sectionectomy in a liver transplant unit. HPB (Oxford) 17, 332–336 (2015). https://doi.org/10.1111/hpb.12354

    Article  Google Scholar 

  40. Yu, Y.-D., Kim, K.-H., Jung, D.-H., Namkoong, J.-M., Yoon, S.-Y., Jung, S.-W., Lee, S.-K., Lee, S.-G.: Robotic versus laparoscopic liver resection: a comparative study from a single center. Langenbeck’s Arch. Surg. 399, 1039–1045 (2014). https://doi.org/10.1007/s00423-014-1238-y

    Article  Google Scholar 

  41. Zhang, X., Yang, J., Yan, L., Li, B., Wen, T., Xu, M., Wang, W., Zhao, J., Wei, Y.: Comparison of laparoscopy-assisted and open donor right hepatectomy: a prospective case-matched study from china. J. Gastrointest. Surg. 18, 744–750 (2014). https://doi.org/10.1007/s11605-013-2425-9

    Article  PubMed  Google Scholar 

  42. Dokmak, S., Raut, V., Aussilhou, B., Fteriche, F.S., Farges, O., Sauvanet, A., Belghiti, J.: Laparoscopic left lateral resection is the gold standard for benign liver lesions: a case-control study. HPB (Oxford). 16, 183–187 (2014). https://doi.org/10.1111/hpb.12108

    Article  PubMed  Google Scholar 

  43. Cannon, R.M., Scoggins, C.R., Callender, G.G., Quillo, A., McMasters, K.M., Martin, R.C.G.: Financial comparison of laparoscopic versus open hepatic resection using deviation-based cost modeling. Ann. Surg. Oncol. (2013). https://doi.org/10.1245/s10434-013-2993-7

    Article  PubMed  Google Scholar 

  44. Abu Hilal, M., Di Fabio, F., Syed, S., Wiltshire, R., Dimovska, E., Turner, D., Primrose, J.N., Pearce, N.W.: Assessment of the financial implications for laparoscopic liver surgery: A single-centre UK cost analysis for minor and major hepatectomy. Surg. Endosc. 27, 2542–2550 (2013). https://doi.org/10.1007/s00464-012-2779-1

    Article  PubMed  Google Scholar 

  45. Packiam, V., Bartlett, D.L., Tohme, S., Reddy, S., Marsh, J.W., Geller, D.A., Tsung, A.: Minimally invasive liver resection: robotic versus laparoscopic left lateral sectionectomy. J. Gastrointest. Surg. 16, 2233–2238 (2012). https://doi.org/10.1007/s11605-012-2040-1

    Article  PubMed  PubMed Central  Google Scholar 

  46. Stoot, J.H., van Dam, R.M., Coelen, R.J., Winkens, B., Olde Damink, S.W., Bemelmans, M.H., Dejong, C.H.: The introduction of a laparoscopic liver surgery programme: a cost analysis of initial experience in a university hospital. Scand. J. Surg. 101, 32–37 (2012). https://doi.org/10.1177/145749691210100107

    Article  CAS  PubMed  Google Scholar 

  47. Cosic, L., Ma, R., Churilov, L., Debono, D., Nikfarjam, M., Christophi, C., Weinberg, L.: The financial impact of postoperative complications following liver resection. Medicine (Baltimore) 98, 16054 (2019). https://doi.org/10.1097/MD.0000000000016054

    Article  Google Scholar 

  48. Bhojani, F.D., Fox, A., Pitzul, K., Gallinger, S., Wei, A., Moulton, C.-A., Okrainec, A., Cleary, S.P.: Clinical and economic comparison of laparoscopic to open liver resections using a 2-to-1 matched pair analysis: An institutional experience. J. Am. Coll. Surg. 214, 184–195 (2012). https://doi.org/10.1016/j.jamcollsurg.2011.10.020

    Article  PubMed  Google Scholar 

  49. Kim, K.H., Jung, D.H., Park, K.M., Lee, Y.J., Kim, D.Y., Kim, K.M., Lee, S.G.: Comparison of open and laparoscopic live donor left lateral sectionectomy. Br. J. Surg. 98, 1302–1308 (2011). https://doi.org/10.1002/bjs.7601

    Article  CAS  PubMed  Google Scholar 

  50. Vanounou, T., Steel, J.L., Nguyen, K.T., Tsung, A., Marsh, J.W., Geller, D.A., Gamblin, T.C.: Comparing the clinical and economic impact of laparoscopic versus open liver resection. Ann. Surg. Oncol. 17, 998–1009 (2010). https://doi.org/10.1245/s10434-009-0839-0

    Article  PubMed  Google Scholar 

  51. Tsinberg, M., Tellioglu, G., Simpfendorfer, C.H., Walsh, M.R., Vogt, D., Fung, J., Berber, E.: Comparison of laparoscopic versus open liver tumor resection: A case-controlled study. Surg. Endosc. 23, 847–853 (2009). https://doi.org/10.1007/s00464-008-0262-9

    Article  PubMed  Google Scholar 

  52. Baker, T.B., Jay, C.L., Ladner, D.P., Preczewski, L.B., Clark, L., Holl, J., Abecassis, M.M.: Laparoscopy-assisted and open living donor right hepatectomy: A comparative study of outcomes. Surgery 146, 815–817 (2009). https://doi.org/10.1016/j.surg.2009.05.022

    Article  Google Scholar 

  53. Rowe, A.J., Meneghetti, A.T., Schumacher, P.A., Buczkowski, A.K., Scudamore, C.H., Panton, O.N.M., Chung, S.W.: Perioperative analysis of laparoscopic versus open liver resection. Surg. Endosc. 23, 1198–1203 (2009). https://doi.org/10.1007/s00464-009-0372-z

    Article  PubMed  Google Scholar 

  54. Polignano, F.M., Quyn, A.J., De Figueiredo, R.S.M., Henderson, N.A., Kulli, C., Tait, I.S.: Laparoscopic versus open liver segmentectomy: Prospective, case-matched, intention-to-treat analysis of clinical outcomes and cost effectiveness. Surg. Endosc. 22, 2564–2570 (2008). https://doi.org/10.1007/s00464-008-0110-y

    Article  PubMed  Google Scholar 

  55. Zhang, K., Zhang, S.-G., Jiang, Y., Gao, P.-F., Xie, H.-Y., Xie, Z.-H.: Laparoscopic hepatic left lateral lobectomy combined with fiber choledochoscopic exploration of the common bile duct and traditional open operation. World J. Gastroenterol. 14, 1133–1136 (2008). https://doi.org/10.3748/wjg.14.1133

    Article  PubMed  PubMed Central  Google Scholar 

  56. Hu, M., Liu, Y., Li, C., Wang, G., Yin, Z., Lau, W.Y., Liu, R.: Robotic versus laparoscopic liver resection in complex cases of left lateral sectionectomy. Int. J. Surg. 67, 54–60 (2019). https://doi.org/10.1016/j.ijsu.2019.05.008

    Article  PubMed  Google Scholar 

  57. Wabitsch, S., Kästner, A., Haber, P.K., Feldbrügge, L., Winklmann, T., Werner, S., Pratschke, J., Schmelzle, M.: Laparoscopic versus open hemihepatectomy-a cost analysis after propensity score matching. Langenbeck’s Arch. Surg. 404, 469–475 (2019). https://doi.org/10.1007/s00423-019-01790-1

    Article  CAS  Google Scholar 

  58. Shu, J., Wang, X.-J., Li, J.-W., Bie, P., Chen, J., Zheng, S.-G.: Robotic-assisted laparoscopic surgery for complex hepatolithiasis: A propensity score matching analysis. Surg. Endosc. 33, 2539–2547 (2019). https://doi.org/10.1007/s00464-018-6547-8

    Article  PubMed  Google Scholar 

  59. Wu, C.-Y., Chen, P.-D., Chou, W.-H., Liang, J.-T., Huang, C.-S., Wu, Y.-M.: Is robotic hepatectomy cost-effective? In view of patient-reported outcomes. Asian J. Surg. 42, 543–550 (2019). https://doi.org/10.1016/j.asjsur.2018.12.010

    Article  PubMed  Google Scholar 

  60. Jajja, M.R., Maxwell, D., Hashmi, S.S., Meltzer, R.S., Lin, E., Sweeney, J.F., Sarmiento, J.M.: Standardization of operative technique in minimally invasive right hepatectomy: Improving cost-value relationship through value stream mapping in hepatobiliary surgery. HPB (Oxford) 21, 566–573 (2019). https://doi.org/10.1016/j.hpb.2018.09.012

    Article  Google Scholar 

  61. Fretland, A.A., Dagenborg, V.J., Bjornelv, G.M.W., Kazaryan, A.M., Kristiansen, R., Fagerland, M.W., Hausken, J., Tonnessen, T.I., Abildgaard, A., Barkhatov, L., Yaqub, S., Rosok, B.I., Bjornbeth, B.A., Andersen, M.H., Flatmark, K., Aas, E., Edwin, B.: Laparoscopic versus open resection for colorectal liver metastases: The OSLO-COMET randomized controlled trial. Ann. Surg. 267, 199–207 (2018). https://doi.org/10.1097/SLA.0000000000002353

    Article  PubMed  Google Scholar 

  62. Maxwell, D.W., Jajja, M.R., Hashmi, S.S., Lin, E., Srinivasan, J.K., Sweeney, J.F., Sarmiento, J.M.: The hidden costs of open hepatectomy: A 10-year, single institution series of right-sided hepatectomies. Am. J. Surg. 219, 110–116 (2020). https://doi.org/10.1016/j.amjsurg.2019.08.016

    Article  PubMed  Google Scholar 

  63. Cortolillo, N., Patel, C., Parreco, J., Kaza, S., Castillo, A.: Nationwide outcomes and costs of laparoscopic and robotic vs. open hepatectomy. J. Robot. Surg. 13, 557–565 (2019). https://doi.org/10.1007/s11701-018-0896-0

    Article  PubMed  Google Scholar 

  64. Chen, J., Li, H., Liu, F., Li, B., Wei, Y.: Surgical outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma for various resection extent. Medicine (Baltimore) 96, e6460–e6460 (2017). https://doi.org/10.1097/MD.0000000000006460

    Article  Google Scholar 

  65. Kingham, T.P., Leung, U., Kuk, D., Gönen, M., D’Angelica, M.I., Allen, P.J., Dematteo, R.P., Laudone, V.P., Jarnagin, W.R., Fong, Y.: Robotic liver resection: A case-matched comparison. World J. Surg. 40, 1422–1428 (2016). https://doi.org/10.1007/s00268-016-3446-9

    Article  PubMed  PubMed Central  Google Scholar 

  66. Lin, T.-L., Alikhanov, R., Kuo, S.-C., Li, W.-F., Chen, C.-L., Wang, S.-H., Lin, C.-C., Liu, Y.-W., Yong, C.-C., Lin, Y.-H., Wang, C.-C.: Less cost by using hanging maneuver and Pringle maneuver in left lateral hepatectomy through small laparotomy wound-experience of Southern Taiwan. World J. Surg. Oncol (2016). https://doi.org/10.1186/s12957-015-0764-6

    Article  PubMed  PubMed Central  Google Scholar 

  67. Okunrintemi, V., Gani, F., Pawlik, T.M.: National trends in postoperative outcomes and cost comparing minimally invasive versus open liver and pancreatic surgery. J. Gastrointest. Surg. 20, 1836–1843 (2016). https://doi.org/10.1007/s11605-016-3267-z

    Article  PubMed  Google Scholar 

  68. Shen, S., Zhang, W., Jiang, L., Yan, L., Yang, J.: Comparison of upper midline incision with and without laparoscopic assistance for living-donor right hepatectomy. Transpl. Proc. 48, 2726–2731 (2016). https://doi.org/10.1016/j.transproceed.2016.03.046

    Article  CAS  Google Scholar 

  69. Untereiner, X., Cagnet, A., Memeo, R., De Blasi, V., Tzedakis, S., Piardi, T., Severac, F., Mutter, D., Kianmanesh, R., Marescaux, J., Sommacale, D., Pessaux, P.: Short-term and middle-term evaluation of laparoscopic hepatectomies compared with open hepatectomies: A propensity score matching analysis. World J. Gastrointest. Surg. 8, 643–650 (2016). https://doi.org/10.4240/wjgs.v8.i9.643

    Article  PubMed  PubMed Central  Google Scholar 

  70. Martin, R.C.G., Mbah, N.A., St Hill, R., Kooby, D., Weber, S., Scoggins, C.R., Maithel, S.K.: Laparoscopic versus open hepatic resection for hepatocellular carcinoma: improvement in outcomes and similar cost. World J. Surg. 39, 1519–1526 (2015). https://doi.org/10.1007/s00268-015-2974-z

    Article  PubMed  Google Scholar 

  71. Liu, L., Li, N.: Feasibility and advantages of large liver hemangioma treated with laparoscopic microwave ablation. Hepatogastroenterology 61, 1068–1073 (2014)

    PubMed  Google Scholar 

  72. Medbery, R.L., Chadid, T.S., Sweeney, J.F., Knechtle, S.J., Kooby, D.A., Maithel, S.K., Lin, E., Sarmiento, J.M.: Laparoscopic vs open right hepatectomy: a value-based analysis. J. Am. Coll. Surg. 218, 929–939 (2014). https://doi.org/10.1016/j.jamcollsurg.2014.01.045

    Article  PubMed  Google Scholar 

  73. Gustafson, J.D., Fox, J.P., Ouellette, J.R., Hellan, M., Termuhlen, P., McCarthy, M.C., Thambi-Pillai, T.: Open versus laparoscopic liver resection: Looking beyond the immediate postoperative period. Surg. Endosc. Other Interv. Tech. 26, 468–472 (2012). https://doi.org/10.1007/s00464-011-1902-z

    Article  Google Scholar 

  74. Fretland, Å.A., Dagenborg, V.J., Waaler Bjørnelv, G.M., Aghayan, D.L., Kazaryan, A.M., Barkhatov, L., Kristiansen, R., Fagerland, M.W., Edwin, B., Andersen, M.H.: Quality of life from a randomized trial of laparoscopic or open liver resection for colorectal liver metastases. Br. J. Surg. 106, 1372–1380 (2019). https://doi.org/10.1002/bjs.11227

    Article  CAS  PubMed  Google Scholar 

  75. Slim, A., Garancini, M., Di Sandro, S., Mangoni, I., Lauterio, A., Giacomoni, A., De Carlis, L.: Laparoscopic versus open liver surgery: a single center analysis of post-operative in-hospital and post-discharge results. Langenbeck’s Arch. Surg. 397, 1305–1311 (2012). https://doi.org/10.1007/s00423-012-0992-y

    Article  Google Scholar 

  76. Ji, W.B., Wang, H.G., Zhao, Z.M., Duan, W.D., Lu, F., Dong, J.H.: Robotic-assisted laparoscopic anatomic hepatectomy in China: Initial experience. Ann. Surg. 253, 342–348 (2011). https://doi.org/10.1097/SLA.0b013e3181ff4601

    Article  PubMed  Google Scholar 

  77. Nguyen, K.T., Marsh, J.W., Tsung, A., Steel, J.J.L., Gamblin, T.C., Geller, D.A.: Comparative benefits of laparoscopic vs open hepatic resection: A critical appraisal. Arch. Surg. (2011). https://doi.org/10.1001/archsurg.2010.248

    Article  PubMed  Google Scholar 

  78. Gani, F., Ejaz, A., Dillhoff, M., He, J., Weiss, M., Wolfgang, C.L., Cloyd, J., Tsung, A., Johnston, F.M., Pawlik, T.M.: A national assessment of the utilization, quality and cost of laparoscopic liver resection. HPB (Oxford) 21, 1327–1335 (2019). https://doi.org/10.1016/j.hpb.2019.02.005

    Article  Google Scholar 

  79. Peng, Y., Liu, F., Xu, H., Lan, X., Wei, Y., Li, B.: Outcomes of Laparoscopic liver resection for patients with multiple hepatocellular carcinomas meeting the milan criteria: a propensity score-matched analysis. J. Laparoendosc. Adv. Surg. Tech. A. 29, 1144–1151 (2019). https://doi.org/10.1089/lap.2019.0362

    Article  PubMed  PubMed Central  Google Scholar 

  80. Chen, Q., Merath, K., Bagante, F., Akgul, O., Dillhoff, M., Cloyd, J., Pawlik, T.M.: A comparison of open and minimally invasive surgery for hepatic and pancreatic resections among the medicare population. J. Gastrointest. Surg. 22, 2088–2096 (2018). https://doi.org/10.1007/s11605-018-3883-x

    Article  PubMed  Google Scholar 

  81. Lee, C.-W., Tsai, H.-I., Cheng, H.-T., Chen, W.-T., Hsu, H.-Y., Chiu, C.-C., Liu, Y.-P., Wu, T.-H., Yu, M.-C., Lee, W.-C., Chen, M.-F.: Stapleless laparoscopic left lateral sectionectomy for hepatocellular carcinoma: Reappraisal of the Louisville statement by a young liver surgeon. BMC Gastroenterol. 18, 178 (2018). https://doi.org/10.1186/s12876-018-0903-y

    Article  PubMed  PubMed Central  Google Scholar 

  82. Li, J., Ren, H., Du, G., Jin, B.: A systematic surgical procedure: The “7+3” approach to laparoscopic right partial hepatectomy [deep segment (S) VI, S VII or S VIII] in 52 patients with liver tumors. Oncol. Lett. 15, 7846–7854 (2018). https://doi.org/10.3892/ol.2018.8345

    Article  PubMed  PubMed Central  Google Scholar 

  83. Okuno, M., Goumard, C., Mizuno, T., Omichi, K., Tzeng, C.-W.D., Chun, Y.S., Aloia, T.A., Fleming, J.B., Lee, J.E., Vauthey, J.-N., Conrad, C.: Operative and short-term oncologic outcomes of laparoscopic versus open liver resection for colorectal liver metastases located in the posterosuperior liver: A propensity score matching analysis. Surg. Endosc. 32, 1776–1786 (2018). https://doi.org/10.1007/s00464-017-5861-x

    Article  PubMed  Google Scholar 

  84. Peng, J.-X., Wang, L.-Z., Diao, J.-F., Tan, Z.-J., Zhong, X.-S., Zhen, Z.-P., Chen, G.-H., He, J.-M.: Major hepatectomy for primary hepatolithiasis: A comparative study of laparoscopic versus open treatment. Surg. Endosc. 32, 4271–4276 (2018). https://doi.org/10.1007/s00464-018-6176-2

    Article  PubMed  PubMed Central  Google Scholar 

  85. Ciria, R., Cherqui, D., Geller, D.A., Briceno, J., Wakabayashi, G.: Comparative short-term benefits of laparoscopic liver resection: 9000 cases and climbing. Ann. Surg. 263, 761–777 (2016). https://doi.org/10.1097/SLA.0000000000001413

    Article  PubMed  Google Scholar 

  86. Kasai, M., Cipriani, F., Gayet, B., Aldrighetti, L., Ratti, F., Sarmiento, J.M., Scatton, O., Kim, K.-H., Dagher, I., Topal, B., Primrose, J., Nomi, T., Fuks, D., Abu Hilal, M.: Laparoscopic versus open major hepatectomy: A systematic review and meta-analysis of individual patient data. Surgery 163, 985–995 (2018). https://doi.org/10.1016/j.surg.2018.01.020

    Article  PubMed  Google Scholar 

  87. Machairas, N., Papaconstantinou, D., Tsilimigras, D.I., Moris, D., Prodromidou, A., Paspala, A., Spartalis, E., Kostakis, I.D.: Comparison between robotic and open liver resection: A systematic review and meta-analysis of short-term outcomes. Updates Surg. 71, 39–48 (2019). https://doi.org/10.1007/s13304-019-00629-0

    Article  PubMed  Google Scholar 

  88. Montalti, R., Berardi, G., Patriti, A., Vivarelli, M., Troisi, R.I.: Outcomes of robotic vs laparoscopic hepatectomy: A systematic review and meta-analysis. World J. Gastroenterol. 21, 8441–8451 (2015). https://doi.org/10.3748/wjg.v21.i27.8441

    Article  PubMed  PubMed Central  Google Scholar 

  89. Ziogas, I.A., Giannis, D., Esagian, S.M., Economopoulos, K.P., Tohme, S., Geller, D.A.: Laparoscopic versus robotic major hepatectomy: A systematic review and meta-analysis. Surg. Endosc. (2020). https://doi.org/10.1007/s00464-020-08008-2

    Article  PubMed  Google Scholar 

  90. Cleary, S.P., Han, H.S., Yamamoto, M., Wakabayashi, G., Asbun, H.J.: The comparative costs of laparoscopic and open liver resection: a report for the 2nd International Consensus Conference on Laparoscopic Liver Resection. Surg. Endosc 30, 4691–4696 (2016). https://doi.org/10.1007/s00464-016-4801-5

    Article  PubMed  Google Scholar 

  91. Nomi, T., Fuks, D., Kawaguchi, Y., Mal, F., Nakajima, Y., Gayet, B.: Learning curve for laparoscopic major hepatectomy. Br. J. Surg. 102, 796–804 (2015). https://doi.org/10.1002/bjs.9798

    Article  CAS  PubMed  Google Scholar 

  92. Nast, K., Swords, K.A.: Decreasing operating room costs via reduction of surgical instruments. J. Pediatr. Urol. (2019). https://doi.org/10.1016/j.jpurol.2019.01.013

    Article  PubMed  Google Scholar 

  93. Vigano, L., Laurent, A., Tayar, C., Tomatis, M., Ponti, A., Cherqui, D.: The learning curve in laparoscopic liver resection: Improved feasibility and reproducibility. Ann. Surg. 250, 772–780 (2009). https://doi.org/10.1097/SLA.0b013e3181bd93b2

    Article  PubMed  Google Scholar 

  94. Villani, V., Bohnen, J.D., Torabi, R., Sabbatino, F., Chang, D.C., Ferrone, C.R.: “Idealized” vs. “true” learning curves: The case of laparoscopic liver resection. HPB 18, 504–509 (2016). https://doi.org/10.1016/j.hpb.2016.03.610

    Article  PubMed  PubMed Central  Google Scholar 

  95. Kluger, M.D., Vigano, L., Barroso, R., Cherqui, D.: The learning curve in laparoscopic major liver resection. J. Hepatobiliary Pancreat. Sci. 20, 131–136 (2013). https://doi.org/10.1007/s00534-012-0571-1

    Article  PubMed  Google Scholar 

  96. Lin, C.-W., Tsai, T.-J., Cheng, T.-Y., Wei, H.-K., Hung, C.-F., Chen, Y.-Y., Chen, C.-M.: The learning curve of laparoscopic liver resection after the Louisville statement 2008: Will it be more effective and smooth? Surg. Endosc. 30, 2895–2903 (2016). https://doi.org/10.1007/s00464-015-4575-1

    Article  PubMed  Google Scholar 

  97. Brown, K.M., Geller, D.A.: What is the learning curve for laparoscopic major hepatectomy? J. Gastrointest. Surg. 20, 1065–1071 (2016). https://doi.org/10.1007/s11605-016-3100-8

    Article  PubMed  Google Scholar 

  98. Winter, J.M., Talamini, M.A., Stanfield, C.L., Chang, D.C., Hundt, J.D., Dackiw, A.P., Campbell, K.A., Schulick, R.D.: Thirty robotic adrenalectomies: a single institution’s experience. Surg. Endosc. 20, 119–124 (2006). https://doi.org/10.1007/s00464-005-0082-0

    Article  CAS  PubMed  Google Scholar 

  99. Barbash, G.I., Glied, S.A.: New technology and health care costs–the case of robot-assisted surgery. N. Engl. J. Med. 363, 701–704 (2010). https://doi.org/10.1056/NEJMp1006602

    Article  CAS  PubMed  Google Scholar 

  100. Ho, C., Tsakonas, E., Tran, K., Cimon, K., Severn, M., Mierzwinski-Urban, M., Corcos, J., Pautler, S.: Robot-assisted surgery compared with open surgery and laparoscopic surgery: clinical effectiveness and economic analyses. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2011 Sep. (CADTH Technology Report, No. 137.) 5, Economic Analysis.

  101. D’Annibale, A., Fiscon, V., Trevisan, P., Pozzobon, M., Gianfreda, V., Sovernigo, G., Morpurgo, E., Orsini, C., Del Monte, D.: The da Vinci robot in right adrenalectomy: considerations on technique. Surg. Laparosc. Endosc. Percutan. Tech. 14, 38–41 (2004)

    Article  PubMed  Google Scholar 

Download references

Funding

Drs. Ziogas, Evangeliou, Mylonas, Athanasiadis, Cherouveim, Geller, Schulick, Alexopoulos, Tsoulfas have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, 1313 21st Avenue South, Nashville, TN, 37232-4753, USA

    Ioannis A. Ziogas & Sophoclis P. Alexopoulos

  2. Surgery Working Group, Society of Junior Doctors, Athens, Greece

    Ioannis A. Ziogas, Alexandros P. Evangeliou, Konstantinos S. Mylonas, Dimitrios I. Athanasiadis & Panagiotis Cherouveim

  3. Aristotle University of Thessaloníki School of Medicine, Thessaloníki, Greece

    Alexandros P. Evangeliou

  4. National and Kapodistrian University of Athens School of Medicine, Athens, Greece

    Konstantinos S. Mylonas

  5. Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA

    Dimitrios I. Athanasiadis

  6. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    David A. Geller

  7. Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Richard D. Schulick

  8. Department of Transplant Surgery, Aristotle University of Thessaloniki School of Medicine, Thessaloníki, Greece

    Georgios Tsoulfas

Authors
  1. Ioannis A. Ziogas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexandros P. Evangeliou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Konstantinos S. Mylonas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dimitrios I. Athanasiadis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Panagiotis Cherouveim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. David A. Geller
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Richard D. Schulick
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sophoclis P. Alexopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Georgios Tsoulfas
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study concept and design: Tsoulfas, Ziogas. Acquisition of data: Evangeliou, Ziogas, Athanasiadis, Cherouveim, Mylonas. Analysis and interpretation of data: Ziogas, Evangeliou, Mylonas, Athanasiadis, Cherouveim, Geller, Schulick, Alexopoulos, Tsoulfas. Drafting of the manuscript: Ziogas, Mylonas, Tsoulfas, Evangeliou, Athanasiadis, Cherouveim, Geller, Schulick, Alexopoulos. Critical revision of the manuscript for important intellectual content: Ziogas, Evangeliou, Mylonas, Athanasiadis, Cherouveim, Geller, Schulick, Alexopoulos, Tsoulfas. Final approval: Ziogas, Evangeliou, Mylonas, Athanasiadis, Cherouveim, Geller, Schulick, Alexopoulos, Tsoulfas. Statistical analysis: Ziogas, Evangeliou, Mylonas. Study supervision: Tsoulfas.

Corresponding author

Correspondence to Ioannis A. Ziogas.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ziogas, I.A., Evangeliou, A.P., Mylonas, K.S. et al. Economic analysis of open versus laparoscopic versus robotic hepatectomy: a systematic review and meta-analysis. Eur J Health Econ 22, 585–604 (2021). https://doi.org/10.1007/s10198-021-01277-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10198-021-01277-1

Keywords

JEL Classification

Search

Navigation