Outcomes of Robotic Hepatectomy in a New Community-hospital Based HPB Program. Lessons Learned and ACS Risk Comparison to Open Surgery Outcomes

Abstract

Introduction: Robotic hepatectomy is safe and feasible when performed by trained surgeons. Universal adoption is limited due to the complexity of the operation and the steep learning curve as well as inherent risks associated with liver resection including bleeding. We describe in our series consecutive robotic hepatectomies performed in a community hospital using ACS score. Methods: Consecutive patients undergoing liver resection surgery by a robotic fellowship trained HPB surgeon at a community hospital setting were evaluated. ACS NISQUIP risk score for any and serious complications, 90-day mortality, 30-day readmission, preoperative embolization as well as conversion to open surgery. Results: 22 consecutive patients underwent robotic hepatectomy surgery. Median: Age was 56.5y, BMI was 29.5. Median expected LOS was 6 days and actual LOS 3 days. Median ACS risk for any complications was 20% and for serious complications was 18%. Median for observed rates of any complications was 13.7%. Major hepatectomy was performed in 31.5% and post-operative bleeding occurred in 4.5% and infection in 13.7%. There was an associated major procedure (Colon resection, pancreaticoduodenectomy etc. ) in 18.7% of patients. There was no mortality and 4.5% readmission rates. There was 87.7% R0 resection rates in this cohort.R0 resection rates. Conclusion: Robotic hepatectomy is safe to perform even in a community hospital setting provided there is technical expertise to do. The outcomes are superior to open surgery as predicted by the ACS NISQUIP risk calculator. In addition, the outcomes are seen even in the learning curve phase of a fellowship trained HPB surgeon.