Robotic versus laparoscopic liver resection in posterosuperior region: a retrospective study of consecutive cases.

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Minimally invasive liver resection of the posterosuperior region is considered a challenging procedure due to poor exposure and difficult bleeding control. A robotic approach is supposed to be advantageous in posterosuperior segmentectomy. Its benefits over laparoscopic liver resection (LLR) remain undetermined. This study compared robotic liver resection (RLR) and LLR in the posterosuperior region performed by a single surgeon. We retrospectively analyzed consecutive RLR and LLR performed by a single surgeon between December 2020 and March 2022. Patient characteristics and perioperative variables were compared. A 1:1 propensity score matched (PSM) analysis was performed between both groups. The analysis included 48 RLR and 57 LLR procedures in the posterosuperior region. After PSM analysis, 41 cases of both groups were retained. In pre-PSM cohort, the operative time in the RLR group was significantly shorter than in the LLR group (160 vs. 208min, P = 0.001), especially in radical resection of malignant tumors (176 vs. 231min, P = 0.004). The total Pringle maneuver duration was also markedly shorter (40 vs. 51min, P = 0.047), and the estimated blood loss in the RLR group was lower (92 vs. 150mL, P = 0.005). The postoperative hospital stay (POHS) in the RLR group was significantly shorter (5.4 vs. 7.5days, P = 0.048). In PSM cohort, operative time in the RLR group was also significantly shorter (163 vs. 193min, P = 0.036), and the estimated blood loss was lower (92 vs. 144mL, P = 0.024). However, the total Pringle maneuver duration and POHS showed no significant difference. The complications were similar between two groups in both pre-PSM and PSM cohorts. RLR in the posterosuperior region was as safe and feasible as LLR. RLR was associated with reduced operative time and blood loss than LLR.