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Updated: Jun 9, 2026
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Robotic Left Hepatectomy using Indocyanine Green Fluorescence Imaging for an Intrahepatic Complex Biliary Cyst
Published on: June 24, 2022
Robotic versus laparoscopic liver resection: a propensity score-matched analysis adjusted for surgical difficulty
Akihisa Nagatsu1, Tatsuhiko Kakisaka2, Shunsuke Shichi1
1Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, North 15th West 7th, Kita-ku, Sapporo, 060-8638, Japan.
Surgical Endoscopy
|June 8, 2026
Summary
Robotic liver resection shows fewer complications and less blood loss than laparoscopic surgery, even considering surgical difficulty. This suggests robotic approaches may offer advantages in complex cases.
Area of Science:
- Minimally Invasive Surgery
- Surgical Oncology
- Gastrointestinal Surgery
Background:
- Robotic liver resection is increasingly adopted, but its benefits over laparoscopic approaches are debated, especially when accounting for surgical difficulty.
- The IWATE difficulty score is a tool to standardize surgical complexity assessments.
Purpose of the Study:
- To compare short-term outcomes of robotic versus laparoscopic liver resection.
- To evaluate the impact of surgical difficulty on the comparison between robotic and laparoscopic liver resection.
Main Methods:
- Retrospective analysis of patients undergoing minimally invasive liver resection (2016-2025).
- Exclusion of patients with combined resections of other organs (except cholecystectomy).
- Propensity score matching (PSM) using demographic, clinical, and surgical difficulty (IWATE score) variables.
Main Results:
- After PSM, 260 patients were analyzed (90 robotic, 170 laparoscopic).
- Robotic liver resection demonstrated significantly lower postoperative complication rates (3.3% vs. 15.3%, p=0.003).
- Reduced intraoperative blood loss was observed in the robotic group, despite longer operative times (345 min vs. 263 min, p<0.001).
Conclusions:
- Robotic liver resection is associated with improved short-term outcomes, including fewer complications and less blood loss.
- The findings suggest a potential benefit of robotic surgery in liver resection, particularly when surgical difficulty is factored in.
- Conversion rates, severe complications, and hospital stay were similar between the two approaches.
