Robotic hepatectomy is a safe and cost-effective alternative to conventional open hepatectomy: A single center experience

Abstract

Presenter: Nathaly Llore MD | MedStar Georgetown University Hospital Background: The majority of liver surgery worldwide continues to be performed open as laparoscopic hepatectomy is technically challenging with a steep learning curve. Robotic surgery overcomes many of the technical limitations of laparoscopy and improves the ability of hepatobiliary surgeons to safely perform minimally invasive hepatectomy. However, the clinical outcomes and cost effectiveness of robotic liver resection are largely unknown. Methods: Adult liver resections performed at a single institution from September 2018 to September 2019 were reviewed. Operative data and clinical outcomes between open and robotic hepatectomy were analyzed. Operative and hospitalization costs were compared between the two groups. Results: There were 25 open and 16 robotic hepatectomies performed during the study period. Clinical characteristics including age, gender, BMI, comorbidities, and presence of underlying cirrhosis were comparable between the groups. Open hepatectomy was performed more often for malignant disease compared to robotic (84% vs. 50%) (P=0.034). Major hepatectomy was performed in 16 (64%) open cases and 9 (56%) robotic cases (P=0.618). Operative time was significantly longer in robotic compared to open hepatectomy (median time 375 vs. 236 minutes) (P=0.038). There were no conversions to open in the robotic group. Estimated blood loss, need for intraoperative transfusion, and major complications (Clavien-Dindo class III-V) were significantly lower in the robotic group (Table 1). Patients undergoing robotic hepatectomy had a significantly shorter length of stay compared to open hepatectomy (median 3 vs. 5 days) (P < 0.001). Operative cost was significantly higher in the robotic group compared to open ($11,759 vs. $7,062) (P < 0.001). However, overall cost (operative and hospitalization) was comparable between the two groups (robotic $15,451 vs. open $18,869) (P=0.106). Conclusion: In this single-center experience robotic hepatectomy was superior to open hepatectomy with regards to blood loss, intraoperative transfusion, length of stay, and major complications. Although operative time and cost were higher in robotic hepatectomy, the overall cost was comparable to open hepatectomy due to shorter hospitalizations.