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Major hepatectomy in elderly patients: possible benefit from robotic platform utilization
Osamu Yoshino1,2, Yifan Wang3, Frances McCarron4
1Division of HPB Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA. osamu.yoshino@austin.org.au.
Surgical Endoscopy
|May 12, 2023
Summary
Robotic hepatectomy in elderly patients significantly reduces hospital and ICU stays compared to laparoscopic approaches. This minimally invasive technique offers improved outcomes and may outweigh initial cost concerns.
Area of Science:
- Minimally Invasive Surgery
- Surgical Oncology
- Geriatric Surgery
Background:
- Hepato-pancreato-biliary (HPB) procedures have limited robotic application due to complexity and unproven benefits.
- Elderly patients can benefit from minimally invasive surgery for major hepatectomy.
Purpose of the Study:
- To compare clinical outcomes of robotic hepatectomy (RH) versus laparoscopic hepatectomy (LH) in elderly patients.
- To evaluate the efficacy of robotic surgery in major hepatectomy for patients aged 65 and older.
Main Methods:
- Retrospective review of 125 patients undergoing major hepatectomy (≥3 segments) between 2010-2021.
- Inclusion criteria: age ≥65 years. Exclusions: multiple resections, complex reconstructions.
- Statistical comparison using Chi-square, Fisher's exact, Wilcoxon, and Kruskal-Wallis tests.
Main Results:
- No significant difference in operative time, blood loss, or major complications between RH and LH.
- RH showed significantly lower conversion rates to open surgery (2.6% vs 31.3%).
- RH resulted in shorter hospital length of stay (4 vs 6 days) and lower ICU admission rates (7.7% vs 75%).
Conclusions:
- Robotic major hepatectomy offers clinical advantages for elderly patients, including reduced hospital and ICU stays.
- These benefits may offset perceived financial disadvantages of robotic surgery.
- Minimally invasive approaches like robotic surgery are beneficial for older adults undergoing major hepatectomy.
