Transition from open to robotic assisted liver resection: A retrospective comparative study. Is experience of laparoscopic liver resections needed?

Abstract

The authors present outcomes of robotic liver resections in comparison with open technique questioning the need to have experience of laparoscopy for such procedures before transition to robotic assisted. Retrospective review of liver resections done robotically from February 2015 to June 2017 compared to matched control cohort of open cases from January 2012 to December 2016. Twenty-one patients in the study group were compared with matched control of 42 open cases (1:2 ratio). The types of procedure were similar in both the groups. There were 4 left lateral hepatectomy, 3 left hepatectomy, and 1 left hepatectomy with hepatico-jejunostomy, 3 right hepatectomy, 3 right posterior sectorectomy, 4 bisegmentectomy and 4 mono-segmentectomy. There were 9 patients with primary liver cancer, 2 each with liver metastasis and carcinoma gall bladder and 8 patients had benign liver disease. Mean blood loss was 370 ± 311 ml in the robotic group compared to 451 ± 330 ml in control group (p = 0.06). Minor complications developed in 19.0% of robotic cases compared to 40.5% in open surgery, while major complications occurred in 4.7% of robotic cases compared to 7.1% of open cases. Mean hospital stay was 5.3 ± 0.8 days for the robotic group and 7.7 ± 4.2 days for open group (p = 0.02). Local tumor recurrence occurred in 1 out of 13 resections done for malignancy in the robotic group and 7 out of 26 in the open group. This study highlights the utility of surgical robots for segmental and complex liver resections with equivalent outcomes and decreased length of hospital stay compared to open surgery without having experience of same with the laparoscopy.