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Journal of Gastrointestinal Surgery

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01-12-2012 | Original Article

Minimally Invasive Liver Resection: Robotic Versus Laparoscopic Left Lateral Sectionectomy

Authors: Vignesh Packiam, David L. Bartlett, Samer Tohme, Srinevas Reddy, J. Wallis Marsh, David A. Geller, Allan Tsung

Published in: Journal of Gastrointestinal Surgery | Issue 12/2012

Abstract

Background

The purpose of this study was to compare the clinical and economic outcomes of robotic versus laparoscopic left lateral sectionectomy (LLS).

Methods

A retrospective analysis was made comparing robotic (n = 11) and laparoscopic (n = 18) LLS performed at the University of Pittsburgh Medical Center between January 2009 and July 2011. Demographic data, operative, and postoperative outcomes were collected.

Results

Demographic and tumor characteristics of robotic and laparoscopic LLS were similar. There were also no significant differences in operative outcomes including estimated blood loss and operating room time. Patients undergoing robotic LLS had more admissions to the ICU (46 versus 6 %), increased rate of minor complications (27 versus 0 %), and longer lengths of stay (4 versus 3 days). There were no significant differences in major complication rates or 90-day mortality. The cost of robotic and laparoscopic LLS was not significantly different when only considering direct costs ($5,130 versus $4,408, p = 0.401). However, robotic LLS costs were significantly greater when including indirect costs, which were estimated to be $1,423 per robotic case ($6,553 versus $4,408, p = 0.021).

Discussion

Robotic LLS yields slightly inferior clinical outcomes and increased cost compared to the laparoscopic approach.

Nguyen KT, Gamblin TC, Geller DA. World review of laparoscopic liver resection-2,804 patients. Ann Surg. 2009 Nov;250(5):831–41.PubMedCrossRef

Nguyen KT, Gamblin TC, Geller DA. Laparoscopic liver resection for cancer. Future Oncol. 2008 Oct;4(5):661–70.PubMedCrossRef

Buell JF, Thomas MT, Rudich S, Marvin M, Nagubandi R, Ravindra KV, Brock G, McMasters KM.. Experience with more than 500 minimally invasive hepatic procedures. Ann Surg. 2008 Sep;248(3):475–86.PubMed

Lefor AT, Flowers JL. Laparoscopic wedge biopsy of the liver. J Am Coll Surg. 1994 Mar;178(3):307–8.PubMed

Rogula T, Gagner M. Current status of the laparoscopic approach to liver resection. J Long Term Eff Med Implants. 2004;14(1):23–31.PubMedCrossRef

Samama G, Chiche L, Brefort JL, Le Roux Y. Laparoscopic anatomical hepatic resection. Report of four left lobectomies for solid tumors. Surg Endosc. 1998 Jan;12(1):76–8.PubMedCrossRef

O’Rourke N, Fielding G. Laparoscopic right hepatectomy: surgical technique. J Gastrointest Surg. 2004 Feb;8(2):213–6.PubMedCrossRef

Gumbs AA, Gayet B. Totally laparoscopic central hepatectomy. J Gastrointest Surg. 2008 Jul;12(7):1153.PubMedCrossRef

Nguyen KT, Laurent A, Dagher I, Geller DA, Steel J, Thomas MT, Marvin M, Ravindra KV, Mejia A, Lainas P, Franco D, Cherqui D, Buell JF, Gamblin TC. Minimally invasive liver resection for metastatic colorectal cancer: a multi-institutional, international report of safety, feasibility, and early outcomes. Ann Surg. 2009 Nov;250(5):842–8.PubMedCrossRef

10.

Nguyen KT, Marsh JW, Tsung A, Steel JJ, Gamblin TC, Geller DA. Comparative benefits of laparoscopic vs open hepatic resection: a critical appraisal. Arch Surg. 2011 Mar;146(3):348–56.PubMedCrossRef

11.

Cherqui D, Laurent A, Tayar C, Chang S, Van Nhieu JT, Loriau J, Karoui M, Duvoux C, Dhumeaux D, Fagniez PL. Laparoscopic liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease: midterm results and perspectives. Ann Surg. 2006 Apr;243(4):499–506.PubMedCrossRef

12.

Belli G, Fantini C, D’Agostino A, Cioffi L, Langella S, Russolillo N, Belli A. Laparoscopic versus open liver resection for hepatocellular carcinoma in patients with histologically proven cirrhosis: short- and middle-term results. Surg Endosc. 2007 Nov;21(11):2004–11.PubMedCrossRef

13.

Chen HY, Juan CC, Ker CG. Laparoscopic liver surgery for patients with hepatocellular carcinoma. Ann Surg Oncol. 2008 Mar;15(3):800–6.PubMedCrossRef

14.

Dagher I, O’Rourke N, Geller DA, Cherqui D, Belli G, Gamblin TC, Lainas P, Laurent A, Nguyen KT, Marvin MR, Thomas M, Ravindra K, Fielding G, Franco D,Buell JF. Laparoscopic major hepatectomy: an evolution in standard of care. Ann Surg. 2009 Nov;250(5):856–60.PubMedCrossRef

15.

Polignano FM, Quyn AJ, de Figueiredo RS, Henderson NA, Kulli C, Tait IS. Laparoscopic versus open liver segmentectomy: prospective, case-matched, intention-to-treat analysis of clinical outcomes and cost effectiveness. Surg Endosc. 2008 Dec;22(12):2564–70.PubMedCrossRef

16.

Lee KF, Cheung YS, Chong CN, Tsang YY, Ng WW, Ling E, Wong J, Lai PB. Laparoscopic versus open hepatectomy for liver tumours: a case control study. Hong Kong Med J. 2007 Dec;13(6):442–8.PubMed

17.

Koffron AJ, Auffenberg G, Kung R, Abecassis M. Evaluation of 300 minimally invasive liver resections at a single institution: less is more. Ann Surg. 2007 Sep;246(3):385–92; discussion 92–4.PubMedCrossRef

18.

Kitisin K, Packiam V, Bartlett DL, Tsung A. A current update on the evolution of robotic liver surgery. Minerva Chir. 2011 Aug;66(4):281–93.PubMed

19.

Choi SB, Park JS, Kim JK, Hyung WJ, Kim KS, Yoon DS, Lee WJ, Kim BR. Early experiences of robotic-assisted laparoscopic liver resection. Yonsei Med J. 2008 Aug 30;49(4):632–8.PubMedCrossRef

20.

Vanounou T, Steel JL, Nguyen KT, Tsung A, Marsh JW, Geller DA, Gamblin TC. Comparing the clinical and economic impact of laparoscopic versus open liver resection. Ann Surg Oncol. 2010 Apr;17(4):998–1009.PubMedCrossRef

21.

Idrees K, Bartlett DL. Robotic liver surgery. Surg Clin North Am. 2010 Aug;90(4):761–74.PubMedCrossRef

22.

Giulianotti PC, Sbrana F, Coratti A, Bianco FM, Addeo P, Buchs NC, Ayloo SM, Benedetti E. Totally robotic right hepatectomy: surgical technique and outcomes. Arch Surg. 2011 Jul;146(7):844–50.PubMedCrossRef

23.

Ji WB, Wang HG, Zhao ZM, Duan WD, Lu F, Dong JH. Robotic-assisted laparoscopic anatomic hepatectomy in China: initial experience. Ann Surg. 2011 Feb;253(2):342–8.PubMedCrossRef

24.

Lesurtel M, Cherqui D, Laurent A, Tayar C, Fagniez PL. Laparoscopic versus open left lateral hepatic lobectomy: a case–control study. J Am Coll Surg. 2003 Feb;196(2):236–42.PubMedCrossRef

25.

Aldrighetti L, Pulitano C, Catena M, Arru M, Guzzetti E, Casati M, Comotti L, Ferla G. A prospective evaluation of laparoscopic versus open left lateral hepatic sectionectomy. J Gastrointest Surg. 2008 Mar;12(3):457–62.PubMedCrossRef

26.

Abu Hilal M, McPhail MJ, Zeidan B, Zeidan S, Hallam MJ, Armstrong T, Primrose JN, Pearce NW. Laparoscopic versus open left lateral hepatic sectionectomy: A comparative study. Eur J Surg Oncol. 2008 Dec;34(12):1285–8.PubMedCrossRef

27.

Chang S, Laurent A, Tayar C, Karoui M, Cherqui D. Laparoscopy as a routine approach for left lateral sectionectomy. Br J Surg. 2007 Jan;94(1):58–63.PubMedCrossRef

28.

Azagra JS, Goergen M, Brondello S, Calmes MO, Philippe P, Schmitz B. Laparoscopic liver sectionectomy 2 and 3 (LLS 2 and 3): towards the “gold standard”. J Hepatobiliary Pancreat Surg. 2009;16(4):422–6.PubMedCrossRef

29.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004 Aug;240(2):205–13.PubMedCrossRef

30.

Koffron A, Geller D, Gamblin TC, Abecassis M. Laparoscopic liver surgery: Shifting the management of liver tumors. Hepatology. 2006 Dec;44(6):1694–700.PubMedCrossRef

31.

Cai XJ, Yang J, Yu H, Liang X, Wang YF, Zhu ZY, Peng SY. Clinical study of laparoscopic versus open hepatectomy for malignant liver tumors. Surg Endosc. 2008 Nov;22(11):2350–6.PubMedCrossRef

32.

Nguyen KT, Geller DA. Outcomes of laparoscopic hepatic resection for colorectal cancer metastases. J Surg Oncol. 2010 Dec 15;102(8):975–7.PubMedCrossRef

33.

Topal B, Fieuws S, Aerts R, Vandeweyer H, Penninckx F. Laparoscopic versus open liver resection of hepatic neoplasms: comparative analysis of short-term results. Surg Endosc. 2008 Oct;22(10):2208–13.PubMedCrossRef

34.

Mirnezami R, Mirnezami AH, Chandrakumaran K, Abu Hilal M, Pearce NW, Primrose JN, Sutcliffe RP. Short- and long-term outcomes after laparoscopic and open hepatic resection: systematic review and meta-analysis. HPB (Oxford). 2011 May;13(5):295–308.CrossRef

35.

Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker CG, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D’Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B,Pinson WC, Martinie J, Vauthey JN, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J,Strasberg S, Chari RS. The international position on laparoscopic liver surgery: The Louisville Statement, 2008. Ann Surg. 2009 Nov;250(5):825–30.PubMedCrossRef

36.

Vigano L, Laurent A, Tayar C, Tomatis M, Ponti A, Cherqui D. The learning curve in laparoscopic liver resection: improved feasibility and reproducibility. Ann Surg. 2009 Nov;250(5):772–82.PubMedCrossRef

37.

Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T, Caravaglios G. Robotics in general surgery: personal experience in a large community hospital. Arch Surg. 2003 Jul;138(7):777–84.PubMedCrossRef

38.

Maeso S, Reza M, Mayol JA, Blasco JA, Guerra M, Andradas E, Plana MN. Efficacy of the Da Vinci surgical system in abdominal surgery compared with that of laparoscopy: a systematic review and meta-analysis. Ann Surg. 2010 Aug;252(2):254–62.PubMedCrossRef

39.

Lotan Y, Cadeddu JA, Gettman MT. The new economics of radical prostatectomy: cost comparison of open, laparoscopic and robot assisted techniques. J Urol. 2004 Oct;172(4 Pt 1):1431–5.PubMedCrossRef

40.

Rawlings AL, Woodland JH, Vegunta RK, Crawford DL. Robotic versus laparoscopic colectomy. Surg Endosc. 2007 Oct;21(10):1701–8.PubMedCrossRef

41.

Park BJ, Flores RM. Cost comparison of robotic, video-assisted thoracic surgery and thoracotomy approaches to pulmonary lobectomy. Thorac Surg Clin. 2008 Aug;18(3):297–300, vii.PubMedCrossRef

42.

Bolenz C, Gupta A, Hotze T, Ho R, Cadeddu JA, Roehrborn CG, Lotan Y. Cost comparison of robotic, laparoscopic, and open radical prostatectomy for prostate cancer. Eur Urol. 2010 Mar;57(3):453–8.PubMedCrossRef

43.

Rowe CK, Pierce MW, Tecci KC, Houck CS, Mandell J, Retik AB, Nguyen HT. A comparative direct cost analysis of pediatric urologic robot-assisted laparoscopic surgery versus open surgery: could robot-assisted surgery be less expensive? J Endourol. 2012; 26(7):871–877PubMedCrossRef

44.

Smith A, Kurpad R, Lal A, Nielsen M, Wallen EM, Pruthi RS. Cost analysis of robotic versus open radical cystectomy for bladder cancer. J Urol. 2010 Feb;183(2):505–9.PubMedCrossRef

45.

Lotan Y. Is robotic surgery cost-effective: no. Curr Opin Urol. 2012 Jan;22(1):66–9.PubMedCrossRef

Title: Minimally Invasive Liver Resection: Robotic Versus Laparoscopic Left Lateral Sectionectomy
Authors: Vignesh Packiam
David L. Bartlett
Samer Tohme
Srinevas Reddy
J. Wallis Marsh
David A. Geller
Allan Tsung
Publication date: 01-12-2012
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 12/2012
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-012-2040-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Minimally Invasive Liver Resection: Robotic Versus Laparoscopic Left Lateral Sectionectomy

Abstract

Background

Methods

Results

Discussion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Discussion

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