Robotic versus laparoscopic liver resections for hepatolithiasis: an international multicenter propensity score matched analysis
- Abstract
- Introduction: Minimally invasive liver resection (MILR) is widely recognized as a safe and beneficial procedure in the treatment of both malignant and benign liver diseases. Hepatolithiasis has traditionally been reported to be endemic only in East Asia, but has seen a worldwide uptrend in recent decades with increasingly frequent and invasive endoscopic instrumentation of the biliary tract for a myriad of conditions. To date, there has been a woeful lack of high-quality evidence comparing the laparoscopic (LLR) and robotic (RLR) approaches to treatment hepatolithiasis.
Methods: This is an international multicenter retrospective analysis of 273 patients who underwent RLR or LRR for hepatolithiasis at 33 centers in 2003-2020. The baseline clinicopathological characteristics and perioperative outcomes of these patients were assessed. To minimize selection bias, 1:1 (48 and 48 cases of RLR and LLR, respectively) and 1:2 (37 and 74 cases of RLR and LLR, respectively) propensity score matching (PSM) was performed.
Results: In the unmatched cohort, 63 (23.1%) patients underwent RLR, and 210 (76.9%) patients underwent LLR. Patient clinicopathological characteristics were comparable between the groups after PSM. After 1:1 and 1:2 PSM, RLR was associated with less blood loss (p = 0.003 in 1:2 PSM; p = 0.005 in 1:1 PSM), less patients with blood loss greater than 300 ml (p = 0.024 in 1:2 PSM; p = 0.027 in 1:1 PSM), and lower conversion rate to open surgery (p = 0.003 in 1:2 PSM; p < 0.001 in 1:1 PSM). There was no significant difference between RLR and LLR in use of the Pringle maneuver, median Pringle maneuver duration, 30-day readmission rate, postoperative morbidity, major morbidity, reoperation, and mortality.
Conclusion: Both RLR and LLR were safe and feasible for hepatolithiasis. RLR was associated with significantly less blood loss and lower open conversion rate.
- Author(s)
- Bong Jun Kwak; Jae Hoon Lee; Ken Min Chin; Nicholas L Syn; Sung Hoon Choi; Tan To Cheung; Adrian K H Chiow; Iswanto Sucandy; Marco V Marino; Mikel Prieto; Charing C Chong; Gi Hong Choi; Mikhail Efanov; T Peter Kingham; Robert P Sutcliffe; Roberto I Troisi; Johann Pratschke; Xiaoying Wang; Mathieu D'Hondt; Chung Ngai Tang; Kohei Mishima; Go Wakabayashi; Daniel Cherqui; Davit L Aghayan; Bjorn Edwin; Olivier Scatton; Atsushi Sugioka; Tran Cong Duy Long; Constantino Fondevila; Mohammad Alzoubi; Mohammad Abu Hilal; Andrea Ruzzenente; Alessandro Ferrero; Paulo Herman; Boram Lee; David Fuks; Federica Cipriani; Qu Liu; Luca Aldrighetti; Rong Liu; Ho-Seong Han; Brian K P Goh
- Issued Date
- 2023
- Type
- Article
- Keyword
- Hepatolithiasis; Laparoscopic liver resection; Minimally invasive liver surgery; Recurrent pyogenic cholangitis; Robotic liver resection
- DOI
- 10.1007/s00464-023-10051-8
- URI
- https://oak.ulsan.ac.kr/handle/2021.oak/16826
- Publisher
- SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES
- Language
- 영어
- ISSN
- 0930-2794
- Citation Volume
- 37
- Citation Number
- 8
- Citation Start Page
- 5855
- Citation End Page
- 5864
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