• Jasper P Sijberden, Tijs J Hoogteijling, Davit Aghayan, Francesca Ratti, Ek-Khoon Tan, Victoria Morrison-Jones, Jacopo Lanari, Louis Haentjens, Kongyuan Wei, Stylianos Tzedakis, John Martinie, Daniel Osei Bordom, Giuseppe Zimmitti, Kaitlyn Crespo, Paolo Magistri, Nadia Russolillo, Simone Conci, Burak Görgec, Andrea Benedetti Cacciaguerra, Daniel D'Souza, Gabriel Zozaya, Cèlia Caula, David Geller, Robles CamposRicardoRDepartment of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain., Roland Croner, Shafiq Rehman, Elio Jovine, Mikhail Efanov, Adnan Alseidi, Riccardo Memeo, Ibrahim Dagher, Felice Giuliante, Ernesto Sparrelid, Jawad Ahmad, Tom Gallagher, Moritz Schmelzle, Rutger-Jan Swijnenburg, Åsmund Avdem Fretland, Federica Cipriani, Ye-Xin Koh, Steven White, Santi Lopez Ben, Fernando Rotellar, Pablo E Serrano, Marco Vivarelli, Andrea Ruzzenente, Alessandro Ferrero, Fabrizio Di Benedetto, Marc G Besselink, Iswanto Sucandy, Robert P Sutcliffe, Dionisios Vrochides, David Fuks, Rong Liu, Mathieu D'Hondt, Umberto Cillo, John N Primrose, GohBrian K PBKPDepartment of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore.Surgery Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore, Sing, Luca A Aldrighetti, Bjørn Edwin, Mohammad Abu Hilal, and International consortium on Minimally Invasive Liver Surgery (I-MILS).
• Department of Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.
• Ann. Surg. 2024 Jul 1; 280 (1): 108117108-117.

ObjectiveTo compare the perioperative outcomes of robotic liver surgery (RLS) and laparoscopic liver surgery (LLS) in various settings.BackgroundClear advantages of RLS over LLS have rarely been demonstrated, and the associated costs of robotic surgery are generally higher than those of laparoscopic surgery. Therefore, the exact role of the robotic approach in minimally invasive liver surgery remains to be defined.MethodsIn this international retrospective cohort study, the outcomes of patients who underwent RLS and LLS for all indications between 2009 and 2021 in 34 hepatobiliary referral centers were compared. Subgroup analyses were performed to compare both approaches across several types of procedures: (1) minor resections in the anterolateral (2, 3, 4b, 5, and 6) or (2) posterosuperior segments (1, 4a, 7, 8), and (3) major resections (≥3 contiguous segments). Propensity score matching was used to mitigate the influence of selection bias. The primary outcome was textbook outcome in liver surgery (TOLS), previously defined as the absence of intraoperative incidents ≥grade 2, postoperative bile leak ≥grade B, severe morbidity, readmission, and 90-day or in-hospital mortality with the presence of an R0 resection margin in case of malignancy. The absence of a prolonged length of stay was added to define TOLS+.ResultsAmong the 10.075 included patients, 1.507 underwent RLS and 8.568 LLS. After propensity score matching, both groups constituted 1.505 patients. RLS was associated with higher rates of TOLS (78.3% vs 71.8%, P < 0.001) and TOLS+ (55% vs 50.4%, P = 0.026), less Pringle usage (39.1% vs 47.1%, P < 0.001), blood loss (100 vs 200 milliliters, P < 0.001), transfusions (4.9% vs 7.9%, P = 0.003), conversions (2.7% vs 8.8%, P < 0.001), overall morbidity (19.3% vs 25.7%, P < 0.001), and microscopically irradical resection margins (10.1% vs. 13.8%, P = 0.015), and shorter operative times (190 vs 210 minutes, P = 0.015). In the subgroups, RLS tended to have higher TOLS rates, compared with LLS, for minor resections in the posterosuperior segments (n = 431 per group, 75.9% vs 71.2%, P = 0.184) and major resections (n = 321 per group, 72.9% vs 67.5%, P = 0.086), although these differences did not reach statistical significance.ConclusionsWhile both produce excellent outcomes, RLS might facilitate slightly higher TOLS rates than LLS.Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.

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