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Robotic Versus Laparoscopic Liver Resection: A Nationwide Propensity Score Matched Analysis
Gabriela Pilz da Cunha1,2,3, Jasper P Sijberden1,2,3, Susan van Dieren1,2
1Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Summary
Robotic liver resection (RLR) offers reduced blood loss, fewer conversions, and shorter hospital stays compared to laparoscopic liver resection (LLR). These benefits in patient outcomes were observed nationwide without compromising safety.
Area of Science:
- Hepatobiliary Surgery
- Minimally Invasive Surgery
- Surgical Technology
Background:
- Minimally invasive liver resection is advancing, with robotic surgery potentially overcoming laparoscopic limitations.
- The clinical benefits of robotic liver resection (RLR) over laparoscopic liver resection (LLR) remain under investigation.
- Patient outcomes associated with RLR versus LLR require comprehensive nationwide comparison.
Purpose of the Study:
- To compare nationwide perioperative outcomes of robotic liver resection (RLR) and laparoscopic liver resection (LLR).
- To evaluate the impact of robotic assistance on patient safety and resource utilization in liver resections.
- To assess the influence of learning curves and other factors on the comparative effectiveness of RLR and LLR.
Main Methods:
- Analysis of nationwide data from the Dutch Hepatobiliary Audit (2014-2022).
- Comparison of 792 RLR cases with 2738 LLR cases, utilizing propensity score matching for bias mitigation.
- Sensitivity analyses were performed to account for learning curves, concurrent procedures, center volume, and conversions.
Main Results:
- After propensity score matching, RLR demonstrated significantly less blood loss (100 mL vs 200 mL) and fewer conversions (4.9% vs 12.8%) compared to LLR.
- Robotic liver resection was associated with a shorter hospital stay (3 days vs 4 days) and reduced major blood loss.
- No significant differences were found in overall/severe morbidity, readmissions, mortality, or R0 resection rates between RLR and LLR.
Conclusions:
- Robotic liver resection leads to reduced blood loss, fewer conversions, and shorter hospital stays compared to laparoscopic liver resection.
- The observed benefits of RLR are achieved without compromising patient safety, even when accounting for learning curve effects.
- A reduction in conversions appears to be a primary driver of the advantages associated with robotic liver resection.
