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Robotic versus laparoscopic liver resections for hepatolithiasis: an international multicenter propensity score matched analysis

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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 KwakJae Hoon LeeKen Min ChinNicholas L SynSung Hoon ChoiTan To CheungAdrian K H ChiowIswanto SucandyMarco V MarinoMikel PrietoCharing C ChongGi Hong ChoiMikhail EfanovT Peter KinghamRobert P SutcliffeRoberto I TroisiJohann PratschkeXiaoying WangMathieu D'HondtChung Ngai TangKohei MishimaGo WakabayashiDaniel CherquiDavit L AghayanBjorn EdwinOlivier ScattonAtsushi SugiokaTran Cong Duy LongConstantino FondevilaMohammad AlzoubiMohammad Abu HilalAndrea RuzzenenteAlessandro FerreroPaulo HermanBoram LeeDavid FuksFederica CiprianiQu LiuLuca AldrighettiRong LiuHo-Seong HanBrian K P Goh
Issued Date
2023
Type
Article
Keyword
HepatolithiasisLaparoscopic liver resectionMinimally invasive liver surgeryRecurrent pyogenic cholangitisRobotic 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
Appears in Collections:
Medicine > Nursing
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