Abstract
Background
Minimally invasive liver surgery is increasing worldwide. The benefit of the robot in this scenario is currently controversially discussed. We compared our robotic cases vs. laparoscopic and open minor hepatic resections and share the experience.
Material and methods
From 2011 to 2015, ten patients underwent robotic and 19 patients underwent laparoscopic minor liver resections in the Department of Surgery, University Hospital Erlangen. These patients were compared to a case-matched control group of 53 patients. The perioperative prospectively collected data were analyzed retrospectively.
Results
Blood loss was significantly decreased in the robotic (306 ml) and laparoscopic (356 ml) vs. the open (903 ml) surgery group (p = 0.001). Mean tumor size was 4.1–4.8 cm in all groups (p = 0.571). Negative surgical margins were present in 94 % of the open and 100 % of the laparoscopic and robotic group (p = 0.882). Time for surgery was enlarged for robotic (321 min) vs. laparoscopic (242 min) and open (186 min) surgery (p = 0.001). Postoperative hospitalization was decreased after robotic (7 days) and laparoscopic (8 days) vs. open (10 days) surgery (p = 0.004). Total morbidity was 17 % for open, 16 % for laparoscopic, and 1 % for robotic cases (p = 0.345). Postoperative pain medication and elevation of liver enzymes were remarkably lower after minimally invasive vs. open procedures.
Conclusion
Minimally invasive liver surgery can be performed safely for minor hepatic resections and should be considered whenever possible. Minor liver resections can be performed by standard laparoscopy equivalent to robotic procedures. Nevertheless, the robot adds a technical upgrade which may have benefits for challenging cases and major liver surgery.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Buell JF et al (2009) The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg 250(5):825–830
Buell JF et al (2008) Experience with more than 500 minimally invasive hepatic procedures. Ann Surg 248(3):475–486
Gigot JF et al (2002) Laparoscopic liver resection for malignant liver tumors: preliminary results of a multicenter European study. Ann Surg 236(1):90–97
Belli G et al (2013) Laparoscopic left hemihepatectomy a consideration for acceptance as standard of care. Surg Endosc 27(8):2721–2726
Wakabayashi G et al (2015) Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 261(4):619–629
Cardinal JS et al (2013) Laparoscopic major hepatectomy: pure laparoscopic approach versus hand-assisted technique. J Hepatobiliary Pancreat Sci 20(2):114–119
Gayet B et al (2007) Totally laparoscopic right hepatectomy. Am J Surg 194(5):685–689
Ishizawa T et al (2012) Laparoscopic segmentectomy of the liver: from segment I to VIII. Ann Surg 256(6):959–964
Gumbs AA, Gayet B (2007) Totally laparoscopic left hepatectomy. Surg Endosc 21(7):1221
Gumbs AA, Gayet B (2008) Totally laparoscopic central hepatectomy. J Gastrointest Surg 12(7):1153
Koffron AJ et al (2007) Evaluation of 300 minimally invasive liver resections at a single institution: less is more. Ann Surg 246(3):385–392, discussion 392–4
Tohme S et al (2015) Minimally invasive resection of colorectal cancer liver metastases leads to an earlier initiation of chemotherapy compared to open surgery. J Gastrointest Surg 19(12):2199–2206
Ho CM et al (2013) Systematic review of robotic liver resection. Surg Endosc 27(3):732–739
Giulianotti PC et al (2012) Robot-assisted right lobe donor hepatectomy. Transpl Int 25(1):e5–e9
Croner RS et al (2015) Pioneering robotic liver surgery in Germany: first experiences with liver malignancies. Front Surg 2:18
Belli G et al (2015) Laparoscopic liver resection for hepatocellular carcinoma in cirrhosis: long-term outcomes. Dig Surg 28(2):134–140
Croome KP, Yamashita MH (2010) Laparoscopic vs open hepatic resection for benign and malignant tumors: an updated meta-analysis. Arch Surg 145(11):1109–1118
Cho SW et al (2011) Safety of liver resection in the elderly: how important is age? Ann Surg Oncol 18(4):1088–1095
Geller DA, Tsung A (2015) Long-term outcomes and safety of laparoscopic liver resection surgery for hepatocellular carcinoma and metastatic colorectal cancer. J Hepatobiliary Pancreat Sci 22(10):728–730
Belli G et al (2009) Laparoscopic redo surgery for recurrent hepatocellular carcinoma in cirrhotic patients: feasibility, safety, and results. Surg Endosc 23(8):1807–1811
Belli G et al (2005) Laparoscopic hepatic resection for completely exophytic hepatocellular carcinoma on cirrhosis. J Hepatobiliary Pancreat Surg 12(6):488–493
Conrad C et al (2012) Laparoscopic portal vein ligation with in situ liver split for failed portal vein embolization. Ann Surg 256(3):E14–E15, author reply e16-7
Costi R et al (2003) Laparoscopic right posterior hepatic bisegmentectomy (segments VII-VIII). Surg Endosc 17(1):162
Dagher I et al (2009) Laparoscopic major hepatectomy: an evolution in standard of care. Ann Surg 250(5):856–860
Lin NC, Nitta H, Wakabayashi G (2013) Laparoscopic major hepatectomy: a systematic literature review and comparison of 3 techniques. Ann Surg 257(2):205–213
Tsung A et al (2014) Robotic versus laparoscopic hepatectomy: a matched comparison. Ann Surg 259(3):549–555
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
All procedures performed in studies involving human participants were in accordance with the ethical standards of the University Hospital Erlangen and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Conflict of interest
The authors declare that they have no competing interests.
Rights and permissions
About this article
Cite this article
Croner, R.S., Perrakis, A., Hohenberger, W. et al. Robotic liver surgery for minor hepatic resections: a comparison with laparoscopic and open standard procedures. Langenbecks Arch Surg 401, 707–714 (2016). https://doi.org/10.1007/s00423-016-1440-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-016-1440-1