Abstract
PurposeMinimally invasive liver surgery (MILS) is a feasible and safe procedure for benign and malignant tumors. There has been an ongoing debate on whether conventional laparoscopic liver resection (LLR) or robotic liver resection (RLR) is superior and if one approach should be favored over the other. We started using LLR in 2010, and introduced RLR in 2013. In the present paper, we report on our experiences with these two techniques as early adopters in Germany.MethodsThe data of patients who underwent MILS between 2010 and 2020 were collected prospectively in the Magdeburg Registry for Minimally Invasive Liver Surgery (MD-MILS). A retrospective analysis was performed regarding patient demographics, tumor characteristics, and perioperative parameters.ResultsWe identified 155 patients fulfilling the inclusion criteria. Of these, 111 (71.6%) underwent LLR and 44 (29.4%) received RLR. After excluding cystic lesions, 113 cases were used for the analysis of perioperative parameters. Resected specimens were significantly bigger in the RLR vs. the LLR group (405 g vs. 169 g, p = 0.002); in addition, the tumor diameter was significantly larger in the RLR vs. the LLR group (5.6 cm vs. 3.7 cm, p = 0.001). Hence, the amount of major liver resections (three or more segments) was significantly higher in the RLR vs. the LLR group (39.0% vs. 16.7%, p = 0.005). The mean operative time was significantly longer in the RLR vs. the LLR group (331 min vs. 181 min, p = 0.0001). The postoperative hospital stay was significantly longer in the RLR vs. the LLR group (13.4 vs. LLR 8.7 days, p = 0.03). The R0 resection rate for solid tumors was higher in the RLR vs. the LLR group but without statistical significance (93.8% vs. 87.9%, p = 0.48). The postoperative morbidity ≥ Clavien-Dindo grade 3 was 5.6% in the LLR vs. 17.1% in the RLR group (p = 0.1). No patient died in the RLR but two patients (2.8%) died in the LLR group, 30 and 90 days after surgery (p = 0.53).ConclusionMinimally invasive liver surgery is safe and feasible. Robotic and laparoscopic liver surgery shows similar and adequate perioperative oncological results for selected patients. RLR might be advantageous for more advanced and technically challenging procedures.
Highlights
The first reported laparoscopic wedge resection of the liver was performed in 1992 in Glasgow, UK
LLR was used for repeated laparoscopic liver resections in patients with a history of open liver resections (OLR) or LLR, but an increased conversion rate of up to 11% was noted
We identified 111 (71.6%) LLR procedures and 44 (29.4%) robotic liver resection (RLR) cases
Summary
The first reported laparoscopic wedge resection of the liver was performed in 1992 in Glasgow, UK. In 2009, Nguyen et al published the first comprehensive metaanalysis on LLR They included 127 articles involving a total of 2804 patients. They reported conversion rates to open surgery of about 4.1%, and a postoperative mortality rate of 0.3% without any intraoperative deaths. LLR was used for repeated laparoscopic liver resections in patients with a history of OLR or LLR, but an increased conversion rate of up to 11% was noted. While blood loss was higher and operative time was longer when performing repeated laparoscopic liver resections after initial open liver surgery, hospital stay and perioperative morbidity rates were independent of the initial operative approach [7]
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