Related Experiment Video
Updated: Jul 18, 2026
Robotic Left Hepatectomy using Indocyanine Green Fluorescence Imaging for an Intrahepatic Complex Biliary Cyst
Published on: June 24, 2022
Comparison of intraoperative and postoperative metrics in robotic vs. laparoscopic liver resections by difficulty -
Michael J Lee1, Amir Ashraf Ganjouei2, Jane Wang2
1Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Background:
Robotic liver resections (RLR) are increasingly adopted, but their clinical advantages over laparoscopic liver resections (LLR) remain unclear. This study compared intraoperative and postoperative outcomes between RLR and LLR across surgical difficulty levels and institutions.
Methods:
We analyzed 1683 patients (456 RLR [27.1 %] and 1227 LLR [72.9 %]) from the Americas Minimally Invasive Liver Resection (AMILES) database (2011-2024). Mixed-effects regression models accounted for institutional clustering. Outcomes included operative time, estimated blood loss, use of Pringle maneuver, intraoperative transfusion, length of stay, and postoperative complications. Subgroup analyses were performed by IWATE difficulty.
Results:
RLR was associated with longer operative times than LLR (227 vs. 157 min; p = 0.004). In advanced-difficulty resections, RLR was associated with fewer major postoperative complications (1.7 % vs. 7.7 %; p = 0.013). Interaction testing demonstrated that the effect of surgical approach on transfusion risk and overall complications differed significantly by difficulty. Between-site heterogeneity in the effect of RLR was observed for operative time, use of Pringle maneuver, and intraoperative transfusion.
Conclusion:
RLR was associated with longer operative times overall, but in advanced-difficulty cases, RLR achieved lower rates of major complications. These findings highlight difficulty- and institution-specific variation that may guide adoption of RLR.
