MINIMALLY INVASIVE HEPATECTOMY IN NORTH AMERICA: LAPAROSCOPIC VERSUS ROBOTIC
Alexander M. Fagenson*, Sunil S. Karhadkar, Antonio Di Carlo, Henry A. Pitt, Kwan N. Lau
Surgery, Temple University Hospital, Philadelphia, PA
Introduction
Minimally invasive hepatectomy (MIH) has been shown to be associated with less blood loss and shorter length of stay compared to open surgery. However, data comparing laparoscopic and robotic hepatectomy is lacking and often limited to single center studies. Therefore, the aim of this analysis was to compare laparoscopic and robotic hepatectomy in a large North American database.
Methods
Patients undergoing major hepatectomy (≥ 3 segments) or partial hepatectomy (≤ 2 segments) were identified in the 2014-17 ACS-NSQIP procedure-targeted database. Patients undergoing pure laparoscopic and robotic approaches were identified and analyzed under an intention to treat method. Propensity score matching was utilized to adjust for inter-group bias. Demographics and outcomes were compared by Mann-Whitney-U and Chi Square tests as appropriate.
Results
From 2014-2017, 12,880 hepatectomies including 4,028 major and 8,852 partial resections were performed. Prior to matching, 3,152 minimally invasive hepatectomies were identified of which 92% (n = 2,905) were laparoscopic and 8% (n = 247) were robotic. Partial hepatectomies were most commonly performed, 86% of laparoscopic (n = 2,493) and 86% of robotic (n = 213). During the four-year analysis, only 412 laparoscopic and 34 robotic major hepatectomies were performed. After matching, 240 patients were identified in each group and were statistically similar at baseline (p > 0.05) (Table 1). Patients undergoing laparoscopic hepatectomy had a significantly higher conversion rate (23% vs. 7.4%, p < 0.001) (Table 2). In addition, the operative time was significantly longer for patients undergoing robotic surgery (204 vs. 159 minutes, p < 0.001). No significant differences were observed between laparoscopic and robotic approaches in terms of mortality (1.3% vs. 0.8%, p = 1.00), overall morbidity (18% vs. 16%, p = 0.47) or serious morbidity (16% vs. 14%, p = 0.61). Median postoperative length of stay was only three days for both minimally invasive techniques.
Conclusions
Minimally invasive hepatectomy (MIH) in North America is performed primarily for partial hepatectomies. MIH is overall safe with low morbidity and mortality. However, laparoscopic hepatectomy is associated with a significantly higher conversion rate but has a shorter operative time when compared to robotic hepatectomy. Both minimally invasive approaches are safe with similar mortality and morbidity profiles as well as a very short length of stay.
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