Prospective multicenter study for robotic anatomical major liver resection : Can robotic beginners safely perform ?

Abstract

Introduction: The robotic surgical system had been widely accepted in various surgical field with the expectations of overcoming the limitation of laparoscopic surgery. However, robotic liver resection had not generalized, so far. Thus, this study aimed to evaluate the feasibility and safety of robotic major liver resection by a prospective multicenter study. Method: From July 2017 to December 2018, five surgeons who were the novice in robotic liver resection but experienced a lot in open and laparoscopic liver resection in five tertiary hospitals performed 46 cases of robotic major anatomical liver resection. Perioperative patient’s clinical data and surgical data including detailed procedure time were prospectively collected. All operations were performed identical procedures for dissection and hemostasis and were a totally robotic approach. Result: Twenty-two cases of left hemihepatectomy, 1 extended left hemihepatectomy, 14 right hemihepatectomy, 2 right anterior sectionectomy, 6 right posterior sectionectomy, and one central bisectionectomy were performed. The most common indications were hepatocellular carcinoma for 21 cases following intrahepatic cholangiocarcinoma for 7 cases, liver metastases for 3 cases. Surgical resection margins for all tumor cases were negative. Total average operation time was 378.58 ± 124.31 (190∼696) minutes and estimated intraoperative blood loss was 276.67 ± 397.41 mL (range, minimal to 2600mL). Overall complications were developed in 16 cases (34.8%). In terms of severe (Clavien-Dindo classification, more than III) surgical complications, there were 3 cases of postoperative fluid collection treated with drainage and one case of bile leakage treated with percutaneous transhepatic biliary drainage. Only one case out of 46 cases was converted to the conventional open left hemihepatectomy because of bleeding. Transfusion was done in 2 patients (4.3%) and Pringle maneuver was applied in 16 (34.8%). Mean hospital stay was 7.3 days. Conclusion: Robotic anatomic major liver resection might be safely performed even by robotic beginners but experienced open liver surgeons.