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Open Access 02-05-2024 | Liver Surgery | Dynamic Manuscript

Full robotic versus open ALPPS: a bi-institutional comparison of perioperative outcomes

Authors: Cristiano Guidetti, Philip C. Müller, Paolo Magistri, Jan Philipp Jonas, Roberta Odorizzi, Philipp Kron, Gianpiero Guerrini, Christian E. Oberkofler, Stefano Di Sandro, Pierre-Alain Clavien, Henrik Petrowsky, Fabrizio Di Benedetto

Published in: Surgical Endoscopy

Abstract

Background

In primarily unresectable liver tumors, ALPPS (Associating Liver Partition and Portal Vein Ligation for Staged hepatectomy) may offer curative two-stage hepatectomy trough a fast and extensive hypertrophy. However, concerns have been raised about the invasiveness of the procedure. Full robotic ALPPS has the potential to reduce the postoperative morbidity trough a less invasive access. The aim of this study was to compare the perioperative outcomes of open and full robotic ALPPS.

Methods

The bicentric study included open ALPPS cases from the University Hospital Zurich, Switzerland and robotic ALPPS cases from the University of Modena and Reggio Emilia, Italy from 01/2015 to 07/2022. Main outcomes were intraoperative parameters and overall complications.

Results

Open and full robotic ALPPS were performed in 36 and 7 cases. Robotic ALPPS was associated with less blood loss after both stages (418 ± 237 ml vs. 319 ± 197 ml; P = 0.04 and 631 ± 354 ml vs. 258 ± 53 ml; P = 0.01) as well as a higher rate of interstage discharge (86% vs. 37%; P = 0.02). OT was longer with robotic ALPPS after both stages (371 ± 70 min vs. 449 ± 81 min; P = 0.01 and 282 ± 87 min vs. 373 ± 90 min; P = 0.02). After ALPPS stage 2, there was no difference for overall complications (86% vs. 86%; P = 1.00) and major complications (43% vs. 39%; P = 0.86). The total length of hospital stay was similar (23 ± 17 days vs. 26 ± 13; P = 0.56).

Conclusion

Robotic ALPPS was safely implemented and showed potential for improved perioperative outcomes compared to open ALPPS in an experienced robotic center. The robotic approach might bring the perioperative risk profile of ALPPS closer to interventional techniques of portal vein embolization/liver venous deprivation.

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Title: Full robotic versus open ALPPS: a bi-institutional comparison of perioperative outcomes
Authors: Cristiano Guidetti
Philip C. Müller
Paolo Magistri
Jan Philipp Jonas
Roberta Odorizzi
Philipp Kron
Gianpiero Guerrini
Christian E. Oberkofler
Stefano Di Sandro
Pierre-Alain Clavien
Henrik Petrowsky
Fabrizio Di Benedetto
Publication date: 02-05-2024
Publisher: Springer US
Keywords: Liver Surgery
Liver Surgery
Published in: Surgical Endoscopy
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-024-10804-z

At a glance: The STEP trials

Springer Medicine

Full robotic versus open ALPPS: a bi-institutional comparison of perioperative outcomes

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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