Robotic or laparoscopic repeat hepatectomy after open hepatectomy: a cohort study

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Minimally invasive surgery

Background:

• Repeat hepatectomies are complex surgical procedures.
• Limited evidence exists for minimally invasive repeat hepatectomies (MIRH) following prior open hepatectomy.
• This study compares MIRH with open repeat hepatectomies (ORH) in patients with liver tumors previously treated with open liver resection.

Purpose of the Study:

• To compare postoperative outcomes of MIRH versus ORH in patients undergoing repeat liver resections.
• To evaluate the feasibility and safety of MIRH after previous open hepatectomy.
• To identify factors associated with the utilization of a minimally invasive approach in repeat hepatectomy.

Main Methods:

• A prospective database identified patients who underwent repeat hepatectomies after open liver resections (April 2018 - May 2023).
• Patients were stratified into MIRH or ORH groups based on intention to treat.
• Postoperative complications were graded using the Clavien-Dindo classification; logistic regression analyzed factors for MIRH utilization.

Main Results:

• Of 46 patients, 20 underwent MIRH and 26 underwent ORH. Advanced repeat hepatectomies were performed in 59% of patients.
• MIRH was associated with significantly less blood loss (450 ml vs. 600 ml) and shorter length of stay (5 days vs. 7 days).
• Resection margins were negative in all patients; postoperative complication rates were similar between MIRH and ORH groups (P=0.298).

Conclusions:

• Minimally invasive repeat hepatectomy (MIRH) is a feasible and safe alternative to open repeat hepatectomy (ORH) after prior open liver resection.
• MIRH demonstrates advantages in reduced blood loss and shorter hospital stays.
• The study provides evidence supporting MIRH for selected patients requiring repeat liver surgery.