Robotic Major Hepatectomy: An Institutional Experience and Clinical Outcomes.

Abstract

Most of the literature has only reported outcomes on robotic minor non-anatomical hepatectomy. This study was undertaken to analyze and examine the safety, feasibly, and perioperative outcomes of robotic major hepatectomy at our institution. All patients undergoing robotic major hepatectomy were prospectively followed. Major hepatectomy was defined as a resection of 3 or more segments. Data are expressed as median (mean ± SD). A total of 170 consecutive patients underwent robotic hepatectomies, of which 100 were major resections involving at least 3 segments. The 100 patients were of median 62 (61 ± 13.0) years, and 46% were women. Median BMI was 29 (29 ± 5.9)kg/m2 and median ASA class was 3 (3 ± 0.5). Thirty percent of robotic major hepatectomies were for hepatocellular carcinoma, 28% were for metastatic adenocarcinoma, 9% were for cholangiocarcinoma, and 5% were for metastatic neuroendocrine tumor. Prep time (in the room until incision) was a median 58min (62 ± 18.4), extraction time (incision until specimen extraction) was 124min (146 ± 99.5), console time was 198min (210 ± 123.9), closure time (extraction until dressing placement) was 109min (131 ± 93.8), operative duration was 246min (269 ± 123.2), and time under anesthesia was 330min (353 ± 109.6). Estimated blood loss was 175ml (249 ± 275.9) and length of stay was 4days (5 ± 4.3). Seven patients experienced postoperative complications. Thirteen patients were readmitted within 30days, and one patient died within 30days. Application of the robotic platform to major hepatectomy is safe and feasible. Our early experience shows that this minimally invasive approach results in excellent short-term outcomes.