Introduction
Minimally Invasive Hepatectomy (MIH) shown to be associated with improved outcomes when compared to open surgery. The aim of this analysis was to compare robotic and open hepatectomy using ACS-NSQIP from 2014-2020.
Methods
Patients undergoing major hepatectomy (? 3 segments) or partial hepatectomy (? 2 segments) were identified in the 2014-2020 ACS-NSQIP procedure-targeted database. Patients undergoing robotic and open approaches were identified and analyzed under an intention to treat method. Laparoscopic and hybrid approaches were excluded. Propensity score matching was utilized to adjust for multiple demographic, procedure and pathologic variables. Demographics and outcomes were compared by Mann-Whitney-U and Chi Square tests as appropriate.
Results
Of the 30,490 hepatectomies reported, 2.4% (N=736) were performed robotically and 72.6% (N=22,147) were done open. A majority of the robotic hepatectomies were partial hepatectomies (97.0%, N=714) and a minority were major resections (2.6%, N=19) (3 unknown).
Prior to matching, multiple outcomes were significantly better (p < 0.001) in the robotic cohort including serious mortality, serious morbidity, postoperative bile leak, post hepatectomy liver failure, organ space infections, deep vein thrombosis and length of stay.
Following propensity score matching, 736 robotic and 736 open liver resections were identified that were statistically similar at baseline (p>0.1). Overall morbidity was significantly lower for patients undergoing robotic surgery compared to open hepatectomy (13.6% vs. 16.5%, p<0.001), and length of stay was two days shorter (3.3 vs. 6.4 days, p<0.001).
Subgroup analyses were performed based on hepatectomy extent. Matched major hepatectomies (N=19 in each cohort) and partial resections (N=714 in each cohort) were then identified and compared. For major hepatectomies, length of stay was more than two days shorter for patients undergoing the robotic approach (3.7 vs. 6.2 days, p<0.005). Overall morbidity (15.5% vs. 16.9%, p=0.715) was not statistically significant. Operative time was similar (263 vs. 267 minutes, p = 0.942).
For patients undergoing partial hepatectomy, overall morbidity was significantly lower for patients undergoing robotic surgery compared to open hepatectomy (13.5% vs. 16.5%, p<0.001). Operative time was significantly shorter (211 vs. 233 minutes, p<0.001) and length of stay was three days shorter for patients undergoing a robotic partial resection (3.2 vs. 6.4 days, p < 0.001).
Conclusions
In this analysis, only 2.4% of hepatectomies were done robotically. Most robotic operations were performed for partial resections. Postoperative morbidity was significantly lower for patients undergoing both major and partial resection. Regardless of hepatectomy extent, length of stay was significantly lower for robotic compared to open resections.
