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01-05-2020 | Liver Resection

Robotic versus laparoscopic hepatectomy: application of the difficulty scoring system

Authors: Charing C. N. Chong, H. T. Lok, Andrew K. Y. Fung, Anthony K. W. Fong, Y. S. Cheung, John Wong, K. F. Lee, Paul B. S. Lai

Published in: Surgical Endoscopy | Issue 5/2020

Abstract

Background

The development of robotic system may help to relieve the difficulties encountered during laparoscopic hepatectomy. A difficulty scoring system (DSS) was developed to assess the difficulty of various laparoscopic liver resection procedures. The aim of this study is to explore if the DSS is applicable in robotic hepatectomy and to compare the outcomes of robotic hepatectomy and laparoscopic hepatectomy among different difficulty levels.

Methods

Clinical data from all consecutive patients who underwent robotic and conventional laparoscopic hepatectomy at the Prince of Wales Hospital, Hong Kong, were prospectively collected and reviewed. The difficulty level of operations was graded using the DSS. Perioperative outcomes of robotic and conventional laparoscopic hepatectomy were compared at each difficulty level.

Results

A total of 107 and 94 patients underwent robotic and laparoscopic hepatectomy during the study period, respectively. Among them, 16 and 2 patients were operated for recurrent pyogenic cholangitis, respectively, and were excluded because no mark for tumour location can be assigned. For robotic hepatectomy, a higher DSS was significantly correlated with higher minor complication rate (p = 0.001), more intraoperative blood loss (p = 0.002), longer operation time (p < 0.001) and longer post-operative hospital stay (p < 0.001). The mean DSS scores of robotic and laparoscopic hepatectomy were 4.5 and 3.6, respectively. (p = 0.004). For cases with low (DSS 1–3) and intermediate (DSS 4–6) difficulty level, there was no significant difference in operative blood loss, operation time and overall complications rate. Only 2 cases (2.2%) with high difficulty level were operated with laparoscopic approach while 20% of patients operated with robotic approach had DSS > 6.

Conclusions

DSS significantly correlated with surgical outcomes in patient who underwent robotic hepatectomy. Perioperative outcomes following robotic and conventional laparoscopic hepatectomy were similar in cases with low and intermediate difficulty. However, robotic system allowed minimally invasive approach in cases with higher difficulty level.

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Title: Robotic versus laparoscopic hepatectomy: application of the difficulty scoring system
Authors: Charing C. N. Chong
H. T. Lok
Andrew K. Y. Fung
Anthony K. W. Fong
Y. S. Cheung
John Wong
K. F. Lee
Paul B. S. Lai
Publication date: 01-05-2020
Publisher: Springer US
Keywords: Liver Resection
Liver Resection
Published in: Surgical Endoscopy / Issue 5/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-019-06976-8

At a glance: The STEP trials

Springer Medicine

Robotic versus laparoscopic hepatectomy: application of the difficulty scoring system

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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