Robotic liver resection for hepatic focal nodular hyperplasia in children: comparison with open surgery

Robot-assisted surgery is becoming increasingly used in pediatric oncology. The present study aimed to evaluate the feasibility and safety of robotic liver resection (RLR) for hepatic focal nodular hyperplasia (FNH) in children and compare surgical outcomes between RLR and open liver resection (OLR).

Pediatric patients with liver FNH undergoing lesion resection between January 2020 and June 2024 were included in the study. Patient demographics, operative details, postoperative outcomes, and follow-up were recorded and analyzed.

A total of 20 patients were included in this study. Twelve patients underwent RLR and eight underwent OLR. In the RLR group, the median age was 93.1 months (range, 28-134 months) with a median weight of 32.4 kg (range, 9.7-80 kg). The median maximum tumor diameter at operation was 62.6 mm (range, 49-80 mm) and the median tumor volume was 94.3 mL (range, 35-254.1 mL). Operative time was 168.5 min (range, 116-245 min), intraoperative blood loss was 23.3 mL (range, 5-50 mL) and the length of postoperative hospital stay was 5.7 days (range, 4-11 days). There was a significant difference (p<0.05) between the RLR and OLR groups for: age (93.1 months vs. 137.6 months), maximum tumor diameter (62.6 mm vs. 98 mm), tumor volume (94.3 mL vs. 496.2 mL), operative time (168.5 min vs. 281.4 min), blood loss (23.3 mL vs. 288.7 mL), and length of postoperative hospital stay (5.7 days vs. 9.5 days). There was a borderline significant association between surgical approach (RLR/OLR) and fluctuation in the magnitude of Alanine aminotransferase (ALT) (odds ratio=0.004, 95% confidence interval: 0.000 to 1.096, p=0.05).

Our initial experience suggested that RLR for hepatic FNH in children was both feasible and safe. Tumors in the RLR group were significantly smaller than the OLR group: it proved possible to excise tumors larger than 250 mL in volume.