Robotic approach for major hepatectomy such as right hepatectomy or extended right hepatectomy is advantageous in terms of shorter duration of hospitalization and lower conversion rates. In a muticenter study reported in JAMA Surgery, researchers carried out a propensity-score-matched analysis of 989 patient undergoing robotic or laparoscopic right hepatectomy or extended right hepatectomy from 2008 to 2020 to compare the outcomes with both approaches. After matching, 220 patients in each group were identified. 

Results showed that the conversion to open surgery was lower with robotic right hepatectomy or extended right hepatectomy compared to laparoscopic surgery; 8.6% vs 17.1%, respectively. Patients undergoing robotic surgery also had a marginally shorter duration of hospitalization; 9.11 vs 9.94 days. A separate analysis was conducted between 2015 and 2020 to reduce the confounding effect of the learning curve. Patients (50 for laparoscopic and 49 for robotic surgery) were recruited after a center′s learning curve was achieved. The length of hospital stay continued to be shorter in patients undergoing robotic surgery; 6 days vs 7 days; the conversion rate was 7.6% vs 10.8%, which was non-significant. The duration of surgery, estimated blood loss or perioperative outcomes were comparable between the two groups.

This study has shown robotic approach for major hepatectomy was associated with lower open conversion rate and shorter hospital stay following surgery compared to laparoscopic approach. Robotic surgery also provides benefits of a shorter learning curve. According to the authors, robotic surgery was safe and effective and may also help “to overcome the initial challenges of minimally invasive RH/ERH”.

Source: Chong CC, et al. JAMA Surg. 2022 Mar 9.  doi: 10.1001/jamasurg.2022.0161.