Detailed Abstract
[Liver Best Oral Presentation - Liver (Liver Disease/Surgery)]
[LV BO-S4] ROBOTIC LIVER SURGERY DOES NOT SIGNIFICANTLY IMPROVE RESULTS IN THE CASE OF a COMPLETED LAPAROSCOPIC LEARNING CURVE: a SINGLE-CENTER, PROPENSITY SCORE- MATCHED STUDY
Marco MAIONE 1, Roberto MONTALTI 1, Gianluca ROMPIANESI 1, Mariano Cesare GIGLIO 1, Gianluca CASSESE 1, Silvia CAMPANILE 1, Lorenzo RAMACI 1, Gianluca BENASSAI 1, Giulia FILARDI 1, Luigi RESCIGNO 1, Roberto Ivan TROISI 1
1 Department of Clinical Medicine And Surgery, Federico II University, Naples, Italy, ITALY
Background : The advantages of the robotic approach in minimally invasive liver surgery (MILS) are still debated. This study compares the short-term outcomes between laparoscopic (LLR) and robotic (RLR) liver resections in a team with completed laparoscopic learning curve (LC).
Methods : MILS data were retrospectively reviewed. A propensity score matched analysis (1:1 ratio) identified two groups of patients with similar characteristics in terms of period of operation, age, gender, ASA score, BMI, diagnosis, previous abdominal surgery, previous liver surgery, postero-superior segments, number and size of lesions and type of hepatectomy. Intraoperative details and post-operative outcomes were then compared.
Results : 231 patients underwent MILS between January 2020 and November 2023 (LLR=192, RLR=77). Propensity score matching identified 124 cases (LLR= 62, RLR = 62). The two groups did not differ in terms of main perioperative outcomes, specifically, blood loss (175 vs 200 ml), hospital stay (5 vs 4.5 days), mortality (0% vs 1.6%), overall morbidity (19.4% vs 25.8%), or tumor margin status in RRL vs LLR groups, respectively. There was a tendency towards fewer conversions and overall complications in the RLR group (6.5 vs 11.3%; 19.4% vs 25.8%, respectively). Operative time was longer in RLR (330 vs 275 min) although not statistically significant. The conversion rate in the robotic group decreased in the years 2020-2021 vs 2022-23 from 9.7% to 3.2%.
Conclusions : Consolidated experience in laparoscopic liver resections diminish the value of the robotic approaches in achieved laparoscopic LC. It is essential to understand which types of liver operations can benefit from the robot.
Methods : MILS data were retrospectively reviewed. A propensity score matched analysis (1:1 ratio) identified two groups of patients with similar characteristics in terms of period of operation, age, gender, ASA score, BMI, diagnosis, previous abdominal surgery, previous liver surgery, postero-superior segments, number and size of lesions and type of hepatectomy. Intraoperative details and post-operative outcomes were then compared.
Results : 231 patients underwent MILS between January 2020 and November 2023 (LLR=192, RLR=77). Propensity score matching identified 124 cases (LLR= 62, RLR = 62). The two groups did not differ in terms of main perioperative outcomes, specifically, blood loss (175 vs 200 ml), hospital stay (5 vs 4.5 days), mortality (0% vs 1.6%), overall morbidity (19.4% vs 25.8%), or tumor margin status in RRL vs LLR groups, respectively. There was a tendency towards fewer conversions and overall complications in the RLR group (6.5 vs 11.3%; 19.4% vs 25.8%, respectively). Operative time was longer in RLR (330 vs 275 min) although not statistically significant. The conversion rate in the robotic group decreased in the years 2020-2021 vs 2022-23 from 9.7% to 3.2%.
Conclusions : Consolidated experience in laparoscopic liver resections diminish the value of the robotic approaches in achieved laparoscopic LC. It is essential to understand which types of liver operations can benefit from the robot.
SESSION
Liver Best Oral Presentation
Room B 3/22/2024 1:30 PM - 2:50 PM