Ruben Ciria1, Giammauro Berardi2,3, Felipe Alconchel4, Javier Briceño1, Gi Hong Choi5, Yao-Ming Wu6, Atsushi Sugioka7, Roberto Ivan Troisi3,8,9, Chady Salloum10,11, Olivier Soubrane12, Johann Pratschke13, John Martinie14, Allan Tsung15, Raphael Araujo16,17,18, Iswanto Sucandy19, Chung N Tang20, Go Wakabayashi2. 1. Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, Córdoba, Spain. 2. Center for Advanced Treatment of HBP Diseases, Ageo Central General Hospital, Saitama, Japan. 3. Department of Human Structure and Repair of Man, Ghent University, Ghent, Belgium. 4. Unit of Hepatobiliary Surgery and Liver Transplantation, Virgen de la Arrixaca University Hospital (IMIB-Arrixaca), Murcia, Spain. 5. Division of Hepatopancreaticobiliary Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. 6. Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan. 7. Department of Surgery, Fujita Health University, Toyoake, Japan. 8. Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy. 9. Department of HPB Surgery and Liver Transplantation, King Faisal Hospital and Research Center, Al Faisal University, Riyadh, Saudi Arabia. 10. Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est, Créteil, France. 11. Centre Hépato-Biliaire, Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris, Université Paris-Sud, Villejuif, France. 12. Department of Hepatobiliary and Liver Transplantation Surgery, Hôpital Beaujon, Paris, France. 13. Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany. 14. Division of HPB Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, NC, USA. 15. Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA. 16. Barretos Cancer Hospital, São Paulo, Brazil. 17. Escola Paulista de Medicina-UNIFESP, São Paulo, Brazil. 18. Hospital Israelita Albert Einstein, São Paulo, Brazil. 19. Digestive Disease Institute, Florida Hospital Tampa, Tampa, FL, USA. 20. Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China.
Abstract
BACKGROUND: The dissemination of robotic liver surgery is slow-paced and must face the obstacle of demonstrating advantages over open and laparoscopic (LLS) approaches. Our objective was to show the current position of robotic liver surgery (RLS) worldwide and to identify if improved short-term outcomes are observed, including secondary meta-analyses for type of resection, etiology, and cost analysis. METHODS: A PRISMA-based systematic review was performed to identify manuscripts comparing RLS vs open or LLS approaches. Quality analysis was performed using the Newcatle-Ottawa score. Statistical analysis was performed after heterogeneity test and fixed- or random-effect models were chosen accordingly. RESULTS: After removing duplications, 2728 RLS cases were identified from the final set of 150 manuscripts. More than 75% of the cases have been performed on malignancies. Meta-analysis from the 38 comparative reports showed that RLS may offer improved short-term outcomes compared to open procedures in most of the variables screened. Compared to LLS, some advantages may be observed in favour of RLS for major resections in terms of operative time, hospital stay and rate of complications. Cost analyses showed an increased cost per procedure of around US$5000. CONCLUSIONS: The advantages of RLS still need to be demonstrated although early results are promising. Advantages vs open approach are demonstrated. Compared to laparoscopic surgery, minor perioperative advantages may be observed for major resections although cost analyses are still unfavorable to the robotic approach.
BACKGROUND: The dissemination of robotic liver surgery is slow-paced and must face the obstacle of demonstrating advantages over open and laparoscopic (LLS) approaches. Our objective was to show the current position of robotic liver surgery (RLS) worldwide and to identify if improved short-term outcomes are observed, including secondary meta-analyses for type of resection, etiology, and cost analysis. METHODS: A PRISMA-based systematic review was performed to identify manuscripts comparing RLS vs open or LLS approaches. Quality analysis was performed using the Newcatle-Ottawa score. Statistical analysis was performed after heterogeneity test and fixed- or random-effect models were chosen accordingly. RESULTS: After removing duplications, 2728 RLS cases were identified from the final set of 150 manuscripts. More than 75% of the cases have been performed on malignancies. Meta-analysis from the 38 comparative reports showed that RLS may offer improved short-term outcomes compared to open procedures in most of the variables screened. Compared to LLS, some advantages may be observed in favour of RLS for major resections in terms of operative time, hospital stay and rate of complications. Cost analyses showed an increased cost per procedure of around US$5000. CONCLUSIONS: The advantages of RLS still need to be demonstrated although early results are promising. Advantages vs open approach are demonstrated. Compared to laparoscopic surgery, minor perioperative advantages may be observed for major resections although cost analyses are still unfavorable to the robotic approach.
Authors: Hye Yeon Yang; Gi Hong Choi; Ken-Min Chin; Sung Hoon Choi; Nicholas L Syn; Tan-To Cheung; Adrian K H Chiow; Iswanto Sucandy; Marco V Marino; Mikel Prieto; Charing C Chong; Jae Hoon Lee; Mikhail Efanov; T Peter Kingham; Robert P Sutcliffe; Roberto I Troisi; Johann Pratschke; Xiaoying Wang; Mathieu D'Hondt; Chung Ngai Tang; Rong Liu; James O Park; Fernando Rotellar; Olivier Scatton; Atsushi Sugioka; Tran Cong Duy Long; Chung-Yip Chan; David Fuks; Ho-Seong Han; Brian K P Goh Journal: Br J Surg Date: 2022-03-15 Impact factor: 6.939
Authors: M D'Hondt; A Devooght; E Willems; D Wicherts; C De Meyere; I Parmentier; A Provoost; H Pottel; C Verslype Journal: J Robot Surg Date: 2022-03-24