Top

Published in:

01-02-2021 | Liver Surgery | Review Article

Laparoscopic versus robotic major hepatectomy: a systematic review and meta-analysis

Authors: Ioannis A. Ziogas, Dimitrios Giannis, Stepan M. Esagian, Konstantinos P. Economopoulos, Samer Tohme, David A. Geller

Published in: Surgical Endoscopy | Issue 2/2021

Abstract

Background

The implementation of the laparoscopic and robotic approaches for major hepatectomy (LMH and RMH) was slower than that for minor hepatectomy, but has significantly increased over the past years. The role or advantages of RMH remains controversial, and we aimed to compare the peri-/postoperative outcomes of LMH versus RMH.

Methods

A systematic literature review was conducted using the MEDLINE and Cochrane Library databases according to the PRISMA guidelines (end-of-search date: March 16th, 2020). Only comparative studies (LMH vs. RMH) reporting on outcomes of interest were included. Meta-analysis was performed using the random-effects model when substantial heterogeneity was encountered; otherwise, the fixed-effects model was implemented. Quality of evidence assessment was performed using the Newcastle–Ottawa Scale.

Results

Seven retrospective cohort studies comparing LMH (n = 300) versus RMH (n = 225) were identified. No significant difference was observed between LMH and RMH regarding overall complications [odds ratio (OR) 1.42, 95% confidence interval (CI) 0.90–2.23; p = 0.13], severe complications (Clavien-Dindo grade ≥ 3) [risk difference (RD) 0.01, 95% CI − 0.03 to 0.05; p = 0.72], and overall mortality (RD 0.00, 95% CI − 0.02 to 0.03; p = 0.73). The two approaches were also equivalent regarding conversion to open hepatectomy (RD 0.03, 95% CI − 0.01 to 0.08; p = 0.15), margin-positive resection (OR 1.34, 95% CI 0.51–3.52; p = 0.55), and transfusion rate (RD − 0.03, 95% CI − 0.16 to 0.11; p = 0.67). No significant difference was observed for LMH versus RMH regarding blood loss [standardized mean difference (SMD) 0.27, 95% CI − 0.24 to 0.77; p = 0.30), operative time (SMD − 0.08, 95% CI − 0.51 to 0.34; p = 0.70), and length of stay (SMD 0.13, 95% CI − 0.58 to 0.84; p = 0.72).

Conclusion

LMH and RMH have equivalent peri-/postoperative outcomes when performed in select patients and high-volume centers.

Available only for authorised users

Nguyen KT, Gamblin TC, Geller DA (2009) World review of laparoscopic liver resection-2,804 patients. Ann Surg 250(5):831–841PubMed

Ciria R, Cherqui D, Geller DA, Briceno J, Wakabayashi G (2016) Comparative short-term benefits of laparoscopic liver resection: 9000 cases and climbing. Ann Surg 263(4):761–777PubMed

Ziogas IA, Tsoulfas G (2017) Advances and challenges in laparoscopic surgery in the management of hepatocellular carcinoma. World J Gastrointest Surg 9(12):233–245PubMedPubMedCentral

Kaneko H, Takagi S, Shiba T (1996) Laparoscopic partial hepatectomy and left lateral segmentectomy: technique and results of a clinical series. Surgery 120(3):468–475PubMed

Descottes B, Glineur D, Lachachi F, Valleix D, Paineau J, Hamy A et al (2003) Laparoscopic liver resection of benign liver tumors. Surg Endosc 17(1):23–30PubMed

Koffron AJ, Auffenberg G, Kung R, Abecassis M (2007) Evaluation of 300 minimally invasive liver resections at a single institution: less is more. Ann Surg 246(3):385–392PubMedPubMedCentral

Troisi R, Montalti R, Smeets P, Van Huysse J, Van Vlierberghe H, Colle I et al (2008) The value of laparoscopic liver surgery for solid benign hepatic tumors. Surg Endosc 22(1):38–44PubMed

Cherqui D, Husson E, Hammoud R, Malassagne B, Stephan F, Bensaid S et al (2000) Laparoscopic liver resections: a feasibility study in 30 patients. Ann Surg 232(6):753–762PubMedPubMedCentral

Soubrane O, Cherqui D, Scatton O, Stenard F, Bernard D, Branchereau S et al (2006) Laparoscopic left lateral sectionectomy in living donors: safety and reproducibility of the technique in a single center. Ann Surg 244(5):815–820PubMedPubMedCentral

10.

Mala T, Edwin B, Rosseland AR, Gladhaug I, Fosse E, Mathisen O (2005) Laparoscopic liver resection: experience of 53 procedures at a single center. J Hepatobiliary Pancreat Surg 12(4):298–303PubMed

11.

Abu Hilal M, Pearce NW (2008) Laparoscopic left lateral liver sectionectomy: a safe, efficient, reproducible technique. Dig Surg 25(4):305–308PubMed

12.

Abu Hilal M, McPhail MJW, Zeidan B, Zeidan S, Hallam MJ, Armstrong T et al (2008) Laparoscopic versus open left lateral hepatic sectionectomy: a comparative study. Eur J Surg Oncol 34(12):1285–1288PubMed

13.

Aldrighetti L, Pulitano C, Catena M, Arru M, Guzzetti E, Casati M et al (2008) A prospective evaluation of laparoscopic versus open left lateral hepatic sectionectomy. J Gastrointest Surg 12(3):457–462PubMed

14.

Buell JF, Thomas MT, Rudich S, Marvin M, Nagubandi R, Ravindra KV et al (2008) Experience with more than 500 minimally invasive hepatic procedures. Ann Surg 248(3):475–485PubMed

15.

Strasberg SM, Belghiti J, Clavien P-A, Gadzijev E, Garden JO, Lau W-Y et al (2000) The Brisbane 2000 terminology of liver anatomy and resections. HPB 2(3):333–339

16.

Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I et al (2009) The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg 250(5):825–830PubMed

17.

Dagher I, Gayet B, Tzanis D, Tranchart H, Fuks D, Soubrane O et al (2014) International experience for laparoscopic major liver resection. J Hepatobiliary Pancreat Sci 21(10):732–736PubMed

18.

Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS et al (2015) Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 261(4):619–629PubMed

19.

Huscher CG, Lirici MM, Chiodini S, Recher A (1997) Current position of advanced laparoscopic surgery of the liver. J R Coll Surg Edinb 42(4):219–225PubMed

20.

O’Rourke N, Fielding G (2004) Laparoscopic right hepatectomy: surgical technique. J Gastrointest Surg 8(2):213–216PubMed

21.

Dagher I, O’Rourke N, Geller DA, Cherqui D, Belli G, Gamblin TC et al (2009) Laparoscopic major hepatectomy: an evolution in standard of care. Ann Surg 250(5):856–860PubMed

22.

Nguyen KT, Geller DA (2010) Laparoscopic liver resection-current update. Surg Clin N Am 90(4):749–760PubMed

23.

Marescaux J, Leroy J, Gagner M, Rubino F, Mutter D, Vix M et al (2001) Transatlantic robot-assisted telesurgery. Nature 413(6854):379–380PubMed

24.

Hanna T, Imber C (2018) Robotics in HPB surgery. Ann R Coll Surg Engl 100(6_sup):31–37PubMed

25.

Nota CL, Rinkes IHB, Molenaar IQ, van Santvoort HC, Fong Y, Hagendoorn J (2016) Robot-assisted laparoscopic liver resection: a systematic review and pooled analysis of minor and major hepatectomies. HPB (Oxford) 18(2):113–120

26.

Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T et al (2003) Robotics in general surgery: personal experience in a large community hospital. Arch Surg 138(7):777–784PubMed

27.

Berber E, Akyildiz HY, Aucejo F, Gunasekaran G, Chalikonda S, Fung J (2010) Robotic versus laparoscopic resection of liver tumours. HPB (Oxford) 12(8):583–586

28.

Troisi RI, Patriti A, Montalti R, Casciola L (2013) Robot assistance in liver surgery: a real advantage over a fully laparoscopic approach? Results of a comparative bi-institutional analysis. Int J Med Robot 9(2):160–166PubMed

29.

Lai ECH, Tang CN (2016) Long-term survival analysis of robotic versus conventional laparoscopic hepatectomy for hepatocellular carcinoma: a comparative study. Surg Laparosc Endosc Percutan Technol 26(2):162–166

30.

Kingham TP, Leung U, Kuk D, Gönen M, D’Angelica MI, Allen PJ et al (2016) Robotic liver resection: a case-matched comparison. World J Surg 40(6):1422–1428PubMedPubMedCentral

31.

Khan S, Beard RE, Kingham PT, Fong Y, Boerner T, Martinie JB et al (2018) Long-term oncologic outcomes following robotic liver resections for primary hepatobiliary malignancies: a multicenter study. Ann Surg Oncol 25(9):2652–2660PubMedPubMedCentral

32.

Lin N-C, Nitta H, Wakabayashi G (2013) Laparoscopic major hepatectomy: a systematic literature review and comparison of 3 techniques. Ann Surg 257(2):205–213PubMed

33.

Wang Z-Y, Chen Q-L, Sun L-L, He S-P, Luo X-F, Huang L-S et al (2019) Laparoscopic versus open major liver resection for hepatocellular carcinoma: systematic review and meta-analysis of comparative cohort studies. BMC Cancer 19(1):1047PubMedPubMedCentral

34.

Tsilimigras DI, Moris D, Vagios S, Merath K, Pawlik TM (2018) Safety and oncologic outcomes of robotic liver resections: a systematic review. J Surg Oncol 117(7):1517–1530PubMed

35.

Qiu J, Chen S, Chengyou D (2016) A systematic review of robotic-assisted liver resection and meta-analysis of robotic versus laparoscopic hepatectomy for hepatic neoplasms. Surg Endosc 30(3):862–875PubMed

36.

Machairas N, Papaconstantinou D, Tsilimigras DI, Moris D, Prodromidou A, Paspala A et al (2019) Comparison between robotic and open liver resection: a systematic review and meta-analysis of short-term outcomes. Updates Surg 71(1):39–48PubMed

37.

Montalti R, Berardi G, Patriti A, Vivarelli M, Troisi RI (2015) Outcomes of robotic vs laparoscopic hepatectomy: a systematic review and meta-analysis. World J Gastroenterol 21(27):8441–8451PubMedPubMedCentral

38.

Guan R, Chen Y, Yang K, Ma D, Gong X, Shen B et al (2019) Clinical efficacy of robot-assisted versus laparoscopic liver resection: a meta analysis. Asian J Surg 42(1):19–31PubMed

39.

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JPA et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700PubMedPubMedCentral

40.

Wohlin C (2014) Guidelines for snowballing in systematic literature studies and a replication in software engineering. In Proceedings of the 18th International Conference on evaluation and assessment in software engineering [Internet]. New York, NY, USA: ACM, p 38:1-38:10. (EASE ’14). http://doi.acm.org/https://doi.org/10.1145/2601248.2601268

41.

Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25(9):603–605PubMed

42.

Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13PubMedPubMedCentral

43.

Wan X, Wang W, Liu J, Tong T (2014) Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 14(1):135PubMedPubMedCentral

44.

Higgins J, Green S (eds) (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0 (updated March 2011). The Cochrane Collaboration. www.handbook.cochrane.org

45.

Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634PubMedPubMedCentral

46.

Tsung A, Geller DA, Sukato DC, Sabbaghian S, Tohme S, Steel J et al (2014) Robotic versus laparoscopic hepatectomy: a matched comparison. Ann Surg 259(3):549–555PubMed

47.

Spampinato MG, Coratti A, Bianco L, Caniglia F, Laurenzi A, Puleo F et al (2014) Perioperative outcomes of laparoscopic and robot-assisted major hepatectomies: an Italian multi-institutional comparative study. Surg Endosc 28(10):2973–2979PubMed

48.

Mejia A, Cheng SS, Vivian E, Shah J, Oduor H, Archarya P (2020) Minimally invasive liver resection in the era of robotics: analysis of 214 cases. Surg Endosc 34(1):339–348PubMed

49.

Marino MV, Shabat G, Guarrasi D, Gulotta G, Komorowski AL (2019) Comparative study of the initial experience in performing robotic and laparoscopic right hepatectomy with technical description of the robotic technique. Dig Surg 36(3):241–250PubMed

50.

Fruscione M, Pickens R, Baker EH, Cochran A, Khan A, Ocuin L et al (2019) Robotic-assisted versus laparoscopic major liver resection: analysis of outcomes from a single center. HPB 21(7):906–911PubMed

51.

Lee SJ, Lee JH, Lee Y-J, Kim SC, Hwang DW, Song KB et al (2019) The feasibility of robotic left-side hepatectomy with comparison of laparoscopic and open approach: consecutive series of single surgeon. Int J Med Robot 15(2):e1982PubMed

52.

Wang Z-Z, Tang W-B, Hu M-G, Zhao Z-M, Zhao G-D, Li C-G et al (2019) Robotic vs laparoscopic hemihepatectomy: a comparative study from a single center. J Surg Oncol 120(4):646–653PubMed

53.

Magistri P, Guerrini GP, Ballarin R, Assirati G, Tarantino G, Di Benedetto F (2019) Improving outcomes defending patient safety: the learning journey in Robotic Liver Resections. Serra R, editor. Biomed Res Int 2019:1835085PubMedPubMedCentral

54.

Nota CL, Borel Rinkes IH, Hagendoorn J (2017) Setting up a robotic hepatectomy program: a Western-European experience and perspective. Hepatobiliary Surg Nutr 6(4):239–245PubMedPubMedCentral

55.

Sugiyama Y, Ishizaki Y, Imamura H, Sugo H, Yoshimoto J, Kawasaki S (2010) Effects of intermittent Pringle’s manoeuvre on cirrhotic compared with normal liver. Br J Surg 97(7):1062–1069PubMed

56.

Nomi T, Fuks D, Kawaguchi Y, Mal F, Nakajima Y, Gayet B (2015) Learning curve for laparoscopic major hepatectomy. Br J Surg 102(7):796–804PubMed

57.

van der Poel MJ, Besselink MG, Cipriani F, Armstrong T, Takhar AS, van Dieren S et al (2016) Outcome and learning curve in 159 consecutive patients undergoing total laparoscopic hemihepatectomy. JAMA Surg 151(10):923–928PubMed

58.

Cheek SM, Geller DA (2016) The learning curve in laparoscopic major hepatectomy: what is the magic number? JAMA Surg 151(10):929PubMed

59.

Brown KM, Geller DA (2016) What is the learning curve for laparoscopic major hepatectomy? J Gastrointest Surg 20(5):1065–1071PubMed

60.

Chen P-D, Wu C-Y, Hu R-H, Chen C-N, Yuan R-H, Liang J-T et al (2017) Robotic major hepatectomy: is there a learning curve? Surgery 161(3):642–649PubMed

61.

Packiam V, Bartlett DL, Tohme S, Reddy S, Marsh JW, Geller DA et al (2012) Minimally invasive liver resection: robotic versus laparoscopic left lateral sectionectomy. J Gastrointest Surg 16(12):2233–2238PubMedPubMedCentral

62.

Kim JK, Park JS, Han DH, Choi GH, Kim KS, Choi JS et al (2016) Robotic versus laparoscopic left lateral sectionectomy of liver. Surg Endosc 30(11):4756–4764PubMed

63.

Yu Y-D, Kim K-H, Jung D-H, Namkoong J-M, Yoon S-Y, Jung S-W et al (2014) Robotic versus laparoscopic liver resection: a comparative study from a single center. Langenbeck’s Arch Surg 399(8):1039–1045

64.

Winter JM, Talamini MA, Stanfield CL, Chang DC, Hundt JD, Dackiw AP et al (2006) Thirty robotic adrenalectomies: a single institution’s experience. Surg Endosc 20(1):119–124PubMed

65.

Barbash GI, Glied SA (2010) New technology and health care costs–the case of robot-assisted surgery. N Engl J Med 363(8):701–704PubMed

66.

Ho C, Tsakonas E, Tran K, Cimon K, Severn M, Mierzwinski-Urban M, et al (2011) Robot-assisted surgery compared with open surgery and laparoscopic surgery: clinical effectiveness and economic analyses. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health. (CADTH Technology Report, No. 137.) 5, ECONOMIC ANALYSIS

67.

D’Annibale A, Fiscon V, Trevisan P, Pozzobon M, Gianfreda V, Sovernigo G et al (2004) The da Vinci robot in right adrenalectomy: considerations on technique. Surg Laparosc Endosc Percutan Technol 14(1):38–41

68.

Betcher RE, Chaney JP, Lacy PR, Otey SK, Wood DJ (2014) Analysis of postoperative pain in robotic versus traditional laparoscopic hysterectomy. J Robot Surg 8(1):35–41PubMed

69.

Melstrom LG, Warner SG, Woo Y, Sun V, Lee B, Singh G et al (2018) Selecting incision-dominant cases for robotic liver resection: towards outpatient hepatectomy with rapid recovery. Hepatobiliary Surg Nutr 7(2):77–84PubMedPubMedCentral

70.

Kose E, Kahramangil B, Aydin H, Donmez M, Aucejo F, Quintini C et al (2020) Minimally invasive resection of posterosuperior liver tumors in the supine position using intra-abdominal trocars. Surg Endosc 34(2):536–543PubMed

71.

Nota CLMA, Molenaar IQ, van Hillegersberg R, Borel Rinkes IHM, Hagendoorn J (2016) Robotic liver resection including the posterosuperior segments: initial experience. J Surg Res 206(1):133–138PubMed

72.

Montalti R, Scuderi V, Patriti A, Vivarelli M, Troisi RI (2016) Robotic versus laparoscopic resections of posterosuperior segments of the liver: a propensity score-matched comparison. Surg Endosc 30(3):1004–1013PubMed

73.

Wabitsch S, Schöning W, Kästner A, Haber PK, Benzing C, Krenzien F et al (2020) A propensity-matched study of full laparoscopic versus hand-assisted minimal-invasive liver surgery. Surg Endosc. https://doi.org/10.1007/s00464-020-07597-2CrossRefPubMed

74.

Fiorentini G, Swaid F, Cipriani F, Ratti F, Heres C, Tsung A, Aldrighetti L, Geller DA (2019) Propensity score matched analysis of pure laparoscopic versus hand-assisted/hybrid major hepatectomy at two western centers. World J Surg 43:2025–2037PubMed

75.

Gumbs AA, Croner R, Rodriguez A, Zuker N, Perrakis A, Gayet B (2013) 200 Consecutive laparoscopic pancreatic resections performed with a robotically controlled laparoscope holder. Surg Endosc 27(10):3781–3791PubMed

76.

Gumbs AA, Gayet B (2013) Adopting Gayet’s techniques of totally laparoscopic liver surgery in the United States. Liver Cancer 2(1):5–15PubMedPubMedCentral

Title: Laparoscopic versus robotic major hepatectomy: a systematic review and meta-analysis
Authors: Ioannis A. Ziogas
Dimitrios Giannis
Stepan M. Esagian
Konstantinos P. Economopoulos
Samer Tohme
David A. Geller
Publication date: 01-02-2021
Publisher: Springer US
Keywords: Liver Surgery
Liver Resection
Liver Surgery
Liver Resection
Published in: Surgical Endoscopy / Issue 2/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-08008-2

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Laparoscopic versus robotic major hepatectomy: a systematic review and meta-analysis

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2021

Insufflation pressure above 25 mm Hg confers no additional benefit over lower pressure insufflation during posterior retroperitoneoscopic adrenalectomy: a retrospective multi-centre propensity score-matched analysis

Transanal total mesorectal excision: the Slagelse experience 2013–2019

Implantation of biologic mesh in ventral hernia repair—does it make sense?

Preoperative predictors of liver decompensation after mini-invasive liver resection

Endoscopic drainage with local infusion of antibiotics to avoid necrosectomy of infected walled-off necrosis

Postoperative analgesic efficacy of continuous wound infusion with local anesthetics after laparoscopy (PAIN): a randomized, double-blind, placebo-controlled trial