Federica Cipriani1, Guido Fiorentini1,2, Paolo Magistri3, Andrea Fontani4, Francesca Menonna5, Mario Annecchiarico6, Andrea Lauterio7, Luciano De Carlis7,8, Andrea Coratti6, Ugo Boggi5, Graziano Ceccarelli4,9, Fabrizio Di Benedetto3, Luca Aldrighetti1,10. 1. Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, Milan, Italy. 2. PhD School in Experimental Medicine, University of Pavia, Pavia, Italy. 3. Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy. 4. General Surgery Division, San Donato Hospital, Arezzo, Italy. 5. General and Transplant Surgery Division, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy. 6. Division of Surgical Oncologic and Robotics, Department of Oncology, Careggi University Hospital, Florence, Italy. 7. Department of General Surgery and Abdominal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy. 8. Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. 9. General Minimally invasive and Robotic Surgery Division, San Matteo degli Infermi Hospital, Spoleto, Italy. 10. Vita-Salute San Raffaele University, Milan, Italy.
Abstract
BACKGROUND: The benefits of pure laparoscopic and robot-assisted liver resections (LLR and RALR) are known in comparison to open surgery. The aim of the present retrospective comparative study is to investigate the role of RALR and LLR according to different levels of difficulty. METHODS: The institutional databases of six high-volume hepatobiliary centers were retrospectively reviewed. The study population was divided in two groups: LLR and RALR. The procedures were stratified for difficulty levels accordingly to three classifications. A propensity score matching was implemented to mitigate selection bias. Short-term outcomes were the object of comparison. RESULTS: Nine hundred and thirty-six LLR and 403 RALR were collected. RALR exhibited fewer cases of intraoperative blood loss, lower transfusion and conversion rates (especially for oncological radicality) than LLR in the setting of highly difficult operations, whereas LLR had lower postoperative morbidity and fewer low-grade complications. For intermediate and low-difficulty resections, the intraoperative advantages of RALR gradually decreased to nonsignificant results and LLR remained associated with lower postoperative morbidity. CONCLUSION: Robot-assisted liver resections do not show operative nor clinically significant benefits over LLR for low- and intermediate-difficulty resections. By reducing conversion rates, RALR can favour the operative feasibility of difficult resections possibly extending the indications of minimally invasive approaches for liver resection.
BACKGROUND: The benefits of pure laparoscopic and robot-assisted liver resections (LLR and RALR) are known in comparison to open surgery. The aim of the present retrospective comparative study is to investigate the role of RALR and LLR according to different levels of difficulty. METHODS: The institutional databases of six high-volume hepatobiliary centers were retrospectively reviewed. The study population was divided in two groups: LLR and RALR. The procedures were stratified for difficulty levels accordingly to three classifications. A propensity score matching was implemented to mitigate selection bias. Short-term outcomes were the object of comparison. RESULTS: Nine hundred and thirty-six LLR and 403 RALR were collected. RALR exhibited fewer cases of intraoperative blood loss, lower transfusion and conversion rates (especially for oncological radicality) than LLR in the setting of highly difficult operations, whereas LLR had lower postoperative morbidity and fewer low-grade complications. For intermediate and low-difficulty resections, the intraoperative advantages of RALR gradually decreased to nonsignificant results and LLR remained associated with lower postoperative morbidity. CONCLUSION: Robot-assisted liver resections do not show operative nor clinically significant benefits over LLR for low- and intermediate-difficulty resections. By reducing conversion rates, RALR can favour the operative feasibility of difficult resections possibly extending the indications of minimally invasive approaches for liver resection.
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: Anne-Sophie Mehdorn; Florian Richter; Katharina Hess; Jan Henrik Beckmann; Jan-Hendrik Egberts; Michael Linecker; Thomas Becker; Felix Braun Journal: J Clin Med Date: 2022-06-19 Impact factor: 4.964
Authors: Manuel Durán; Javier Briceño; Ana Padial; Ferdinando Massimiliano Anelli; Juan Manuel Sánchez-Hidalgo; María Dolores Ayllón; Rafael Calleja-Lozano; Carmen García-Gaitan Journal: World J Hepatol Date: 2022-01-27