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Robotic versus laparoscopic resections of posterosuperior segments of the liver: a propensity score-matched comparison

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Abstract

Background

Open parenchymal-preserving resection is the current standard of care for lesions in the posterosuperior liver segments. Laparoscopy and robot-assisted surgery are emergent surgical approaches for liver resections, even in posteriorly located lesions. The objective of this study was to compare robot-assisted to laparoscopic parenchymal-preserving liver resections for lesions located in segments 7, 8, 4a, and 1.

Methods

Demographics, comorbidities, clinicopathologic characteristics, surgical treatments, and outcomes from patients who underwent laparoscopic and robot-assisted liver resection in two centers for lesions in the posterosuperior segments between June 2008 and February 2014 were reviewed. A 1:2 matched propensity score analysis was performed by individually matching patients in the robotic cohort to patients in the laparoscopic cohort based on demographics, comorbidities, performance status, tumor stage, location, and type of resection.

Results

Thirty-six patients who underwent robot-assisted liver resection were matched with 72 patients undergoing laparoscopic liver resection. Matched patients displayed no significant differences in postoperative outcomes as measured by blood loss, hospital stay, R0 negative margin rate, and mortality. The overall morbidity according to the comprehensive complication index was also similar (34.6 ± 33 vs. 18.4 ± 11.3, respectively, for robotic and laparoscopic approach, p = 0.11). Patients undergoing robotic liver surgery had significantly longer inflow occlusion time (77 vs. 25 min, p = 0.001) as compared with their laparoscopic counterparts.

Conclusions

Although number and severity of complications in the robotic group appears to be higher, robotic and laparoscopic parenchymal-preserving liver resections in the posterosuperior segments display similar safety and feasibility.

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References

  1. Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker CG, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D’Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey JN, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasberg S, Chari RS, World Consensus Conference on Laparoscopic S (2009) The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg 250:825-830

  2. Cherqui D, Husson E, Hammoud R, Malassagne B, Stephan F, Bensaid S, Rotman N, Fagniez PL (2000) Laparoscopic liver resections: a feasibility study in 30 patients. Ann Surg 232:753–762

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. Dulucq JL, Wintringer P, Stabilini C, Berticelli J, Mahajna A (2005) Laparoscopic liver resections: a single center experience. Surg Endosc 19:886–891

    Article  CAS  PubMed  Google Scholar 

  4. Cho JY, Han HS, Yoon YS, Shin SH (2008) Feasibility of laparoscopic liver resection for tumors located in the posterosuperior segments of the liver, with a special reference to overcoming current limitations on tumor location. Surgery 144:32–38

    Article  PubMed  Google Scholar 

  5. Laurent A, Cherqui D, Lesurtel M, Brunetti F, Tayar C, Fagniez PL (2003) Laparoscopic liver resection for subcapsular hepatocellular carcinoma complicating chronic liver disease. Arch Surg 138(3):763–769 (discussion 769)

    Article  PubMed  Google Scholar 

  6. Kazaryan AM, Rosok BI, Marangos IP, Rosseland AR, Edwin B (2011) Comparative evaluation of laparoscopic liver resection for posterosuperior and anterolateral segments. Surg Endosc 25:3881–3889

    Article  PubMed Central  PubMed  Google Scholar 

  7. Xiang L, Xiao L, Li J, Chen J, Fan Y, Zheng S (2015) Safety and feasibility of laparoscopic hepatectomy for hepatocellular carcinoma in the posterosuperior liver segments. World J Surg 39(5):1202–1209

    Article  PubMed  Google Scholar 

  8. Yoon YS, Han HS, Cho JY, Ahn KS (2010) Total laparoscopic liver resection for hepatocellular carcinoma located in all segments of the liver. Surg Endosc 24:1630–1637

    Article  PubMed  Google Scholar 

  9. Dagher I, Proske JM, Carloni A, Richa H, Tranchart H, Franco D (2007) Laparoscopic liver resection: results for 70 patients. Surg Endosc 21:619–624

    Article  CAS  PubMed  Google Scholar 

  10. Nitta H, Sasaki A, Fujita T, Itabashi H, Hoshikawa K, Takahara T, Takahashi M, Nishizuka S, Wakabayashi G (2010) Laparoscopy-assisted major liver resections employing a hanging technique: the original procedure. Ann Surg 251:450–453

    Article  PubMed  Google Scholar 

  11. Desai PH, Lin JF, Slomovitz BM (2014) Milestones to optimal adoption of robotic technology in gynecology. Obstet Gynecol 123:13–20

    Article  PubMed  Google Scholar 

  12. Antoniou SA, Antoniou GA, Koch OO, Pointner R, Granderath FA (2012) Robot-assisted laparoscopic surgery of the colon and rectum. Surg Endosc 26:1–11

    Article  PubMed  Google Scholar 

  13. Autorino R, Zargar H, Kaouk JH (2014) Robotic-assisted laparoscopic surgery: recent advances in urology. Fertil steril 102(4):939–949

    Article  PubMed  Google Scholar 

  14. Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T, Caravaglios G (2003) Robotics in general surgery: personal experience in a large community hospital. Arch Surg 138:777–784

    Article  PubMed  Google Scholar 

  15. Gagner M, Rheault M, Dubuc J (1992) Laparoscopic partial hepatectomy for liver tumor. Surg Endosc 6:99

    Google Scholar 

  16. Kitisin K, Packiam V, Bartlett DL, Tsung A (2011) A current update on the evolution of robotic liver surgery. Minerva Chir 66:281–293

    CAS  PubMed  Google Scholar 

  17. Fisher SB, Kneuertz PJ, Dodson RM, Patel SH, Maithel SK, Sarmiento JM, Russell MC, Cardona K, Choti MA, Staley CA 3rd, Pawlik TM, Kooby DA (2013) A comparison of right posterior sectorectomy with formal right hepatectomy: a dual-institution study. HPB 15:753–762

    Article  PubMed Central  PubMed  Google Scholar 

  18. Berber E, Akyildiz HY, Aucejo F, Gunasekaran G, Chalikonda S, Fung J (2010) Robotic versus laparoscopic resection of liver tumours. HPB 12:583–586

    Article  PubMed Central  PubMed  Google Scholar 

  19. Ji WB, Wang HG, Zhao ZM, Duan WD, Lu F, Dong JH (2011) Robotic-assisted laparoscopic anatomic hepatectomy in China: initial experience. Ann Surg 253:342–348

    Article  PubMed  Google Scholar 

  20. Troisi RI, Patriti A, Montalti R, Casciola L (2013) Robot assistance in liver surgery: a real advantage over a fully laparoscopic approach? results of a comparative bi-institutional analysis. MRCAS 9:160–166

    PubMed  Google Scholar 

  21. Lai EC, Yang GP, Tang CN (2013) Robot-assisted laparoscopic liver resection for hepatocellular carcinoma: short-term outcome. Am J Surg 205:697–702

    Article  PubMed  Google Scholar 

  22. Wu YM, Hu RH, Lai HS, Lee PH (2014) Robotic-assisted minimally invasive liver resection. Asian J Surg 37:53–57

    Article  CAS  PubMed  Google Scholar 

  23. Tsung A, Geller DA, Sukato DC, Sabbaghian S, Tohme S, Steel J, Marsh W, Reddy SK, Bartlett DL (2014) Robotic versus laparoscopic hepatectomy: a matched comparison. Ann Surg 259:549–555

    Article  PubMed  Google Scholar 

  24. Spampinato MG, Coratti A, Bianco L, Caniglia F, Laurenzi A, Puleo F, Ettorre GM, Boggi U (2014) Perioperative outcomes of laparoscopic and robot-assisted major hepatectomies: an Italian multi-institutional comparative study. Surg endosc 28(10):2973–2979

    Article  PubMed  Google Scholar 

  25. Meunier A, Petersson A, Good L, Berlin G (2008) Validation of a haemoglobin dilution method for estimation of blood loss. Vox Sang 95:120–124

    Article  CAS  PubMed  Google Scholar 

  26. Gold JS, Are C, Kornprat P, Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Blumgart LH, D’Angelica M (2008) Increased use of parenchymal-sparing surgery for bilateral liver metastases from colorectal cancer is associated with improved mortality without change in oncologic outcome: trends in treatment over time in 440 patients. Ann Surg 247:109–117

    Article  PubMed  Google Scholar 

  27. Montalti R, Berardi G, Laurent S, Sebastiani S, Ferdinande L, Libbrecht LJ, Smeets P, Brescia A, Rogiers X, de Hemptinne B, Geboes K, Troisi RI (2014) Laparoscopic liver resection compared to open approach in patients with colorectal liver metastases improves further resectability: oncological outcomes of a case–control matched-pairs analysis. Eur J Surg Oncol 40:536–544

    Article  CAS  PubMed  Google Scholar 

  28. von Heesen M, Schuld J, Sperling J, Grunhage F, Lammert F, Richter S, Schilling MK, Kollmar O (2012) Parenchyma-preserving hepatic resection for colorectal liver metastases. Langenbecks Arch Surg 397:383–395

    Article  Google Scholar 

  29. Strasberg SM (2005) Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. J Hepatobiliary Pancreat Surg 12(5):351–355

    Article  PubMed  Google Scholar 

  30. Schultz NA, Larsen PN, Klarskov B, Plum LM, Frederiksen HJ, Christensen BM, Kehlet H, Hillingso JG (2013) Evaluation of a fast-track programme for patients undergoing liver resection. Br J surg 100:138–143

    Article  CAS  PubMed  Google Scholar 

  31. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed Central  PubMed  Google Scholar 

  32. Slankamenac K, Graf R, Barkun J, Puhan MA, Clavien PA (2013) The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg 258:1–7

    Article  PubMed  Google Scholar 

  33. Casciola L, Patriti A, Ceccarelli G, Bartoli A, Ceribelli C, Spaziani A (2011) Robot-assisted parenchymal-sparing liver surgery including lesions located in the posterosuperior segments. Surg Endosc 25:3815–3824

    Article  PubMed  Google Scholar 

  34. Patriti A, Ceccarelli G, Bartoli A, Casciola L (2011) Extracorporeal Pringle maneuver in robot-assisted liver surgery. Surg Laparosc Endosc Percutan Tech 21:e242–e244

    Article  PubMed  Google Scholar 

  35. Casciola L, Codacci-Pisanelli M, Ceccarelli G, Bartoli A, Di Zitti L, Patriti A (2008) A modified umbilical incision for specimen extraction after laparoscopic abdominal surgery. Surg Endosc 22:784–786

    Article  CAS  PubMed  Google Scholar 

  36. PS Matching in SPSS. http://sourceforge.net/projects/psmspss/

  37. Thoemmes F (2012) Propensity score matching in SPSS. http://arxiv.org/ftp/arxiv/papers/1201/1201.6385.pdf

  38. Vibert E, Perniceni T, Levard H, Denet C, Shahri NK, Gayet B (2006) Laparoscopic liver resection. Br J surg 93:67–72

    Article  CAS  PubMed  Google Scholar 

  39. Makuuchi M, Yamamoto J, Takayama T, Kosuge T, Gunven P, Yamazaki S, Hasegawa H (1991) Extrahepatic division of the right hepatic vein in hepatectomy. Hepatogastroenterology 38:176–179

    CAS  PubMed  Google Scholar 

  40. Ishizawa T, Gumbs AA, Kokudo N, Gayet B (2012) Laparoscopic segmentectomy of the liver: from segment I–VIII. Ann Surg 256:959–964

    Article  PubMed  Google Scholar 

  41. Araki K, Conrad C, Ogiso S, Kuwano H, Gayet B (2014) Intraoperative ultrasonography of laparoscopic hepatectomy: key technique for safe liver transection. J Am Coll Surg 218:e37–e41

    Article  PubMed  Google Scholar 

  42. Schneider CM, Peng PD, Taylor RH, Dachs GW 2nd, Hasser CJ, DiMaio SP, Choti MA (2012) Robot-assisted laparoscopic ultrasonography for hepatic surgery. Surgery 151:756–762

    Article  PubMed  Google Scholar 

  43. Yoon YS, Han HS, Cho JY, Kim JH, Kwon Y (2013) Laparoscopic liver resection for centrally located tumors close to the hilum, major hepatic veins, or inferior vena cava. Surgery 153:502–509

    Article  PubMed  Google Scholar 

  44. Nguyen KT, Marsh JW, Tsung A, Steel JJ, Gamblin TC, Geller DA (2011) Comparative benefits of laparoscopic vs open hepatic resection: a critical appraisal. Arch Surg 146:348–356

    Article  PubMed  Google Scholar 

  45. Kim HH, Park EK, Seoung JS, Hur YH, Koh YS, Kim JC, Cho CK, Kim HJ (2011) Liver resection for hepatocellular carcinoma: case-matched analysis of laparoscopic versus open resection. J Korean Surg Soc 80:412–419

    Article  PubMed Central  PubMed  Google Scholar 

  46. Abu Hilal M, Underwood T, Zuccaro M, Primrose J, Pearce N (2010) Short- and medium-term results of totally laparoscopic resection for colorectal liver metastases. Br J surg 97:927–933

    Article  CAS  PubMed  Google Scholar 

  47. Ikeda T, Mano Y, Morita K, Hashimoto N, Kayashima H, Masuda A, Ikegami T, Yoshizumi T, Shirabe K, Maehara Y (2013) Pure laparoscopic hepatectomy in semiprone position for right hepatic major resection. J Hepato-Biliary-Pancreat Sci 20:145–150

    Article  Google Scholar 

  48. Lai EC, Tang CN, Yang GP, Li MK (2011) Multimodality laparoscopic liver resection for hepatic malignancy—from conventional total laparoscopic approach to robot-assisted laparoscopic approach. Int J surg 9:324–328

    Article  PubMed  Google Scholar 

  49. Packiam V, Bartlett DL, Tohme S, Reddy S, Marsh JW, Geller DA, Tsung A (2012) Minimally invasive liver resection: robotic versus laparoscopic left lateral sectionectomy. J Gastrointest Surg 16:2233–2238

    Article  PubMed Central  PubMed  Google Scholar 

  50. Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Seong Han H, Asbun H, O’Rourke N, Tanabe M, Koffron AJ, Tsung A, Soubrane O, Machado MA, Gayet B, Troisi RI, Pessaux P, Van Dam RM, Scatton O, Abu Hilal M, Belli G, Kwon CHD, Edwin B, Choi GH, Aldrighetti LA, Cai X, Cleary S, Chen K-H, Schön MR, 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 SM (2015) Current status and recommendations for laparoscopic liver resection: a report from the 2nd international consensus conference held in IWATE. Ann Surg (In press)

  51. Vigano L, Laurent A, Tayar C, Tomatis M, Ponti A, Cherqui D (2009) The learning curve in laparoscopic liver resection: improved feasibility and reproducibility. Ann Surg 250:772–782

    Article  PubMed  Google Scholar 

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Disclosures

Roberto Montalti, Vincenzo Scuderi, Alberto Patriti, Marco Vivarelli, and Roberto I. Troisi declared that have no conflicts of interest or financial ties to disclose.

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Montalti, R., Scuderi, V., Patriti, A. et al. Robotic versus laparoscopic resections of posterosuperior segments of the liver: a propensity score-matched comparison. Surg Endosc 30, 1004–1013 (2016). https://doi.org/10.1007/s00464-015-4284-9

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  • DOI: https://doi.org/10.1007/s00464-015-4284-9

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