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An international multicentre propensity score matched analysis comparing between robotic versus laparoscopic left lateral sectionectomy

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Abstract

Background

Left lateral sectionectomy (LLS) is one of the most commonly performed minimally invasive liver resections. While laparoscopic (L)-LLS is a well-established technique, over traditional open resection, it remains controversial if robotic (R)-LLS provides any advantages of L-LLS.

Methods

A post hoc analysis of 997 patients from 21 international centres undergoing L-LLS or R-LLS from 2006 to 2020 was conducted. A total of 886 cases (214 R-LLS, 672 L-LLS) met study criteria. 1:1 and 1:2 propensity score matched (PSM) comparison was performed between R-LLS & L-LLS. Further subset analysis by Iwate difficulty was also performed. Outcomes measured include operating time, blood loss, open conversion, readmission rates, morbidity and mortality.

Results

Comparison between R-LLS and L-LLS after PSM 1:2 demonstrated statistically significantly lower open conversion rate in R-LLS than L-LLS (0.6% versus 5%, p = 0.009) and median blood loss was also statistically significantly lower in R-LLS at 50 (80) versus 100 (170) in L-LLS (p = 0.011) after PSM 1:1 although there was no difference in the blood transfusion rate. Pringle manoeuvre was also found to be used more frequently in R-LLS, with 53(24.8%) cases versus to 84(12.5%) L-LLS cases (p < 0.001). There was no significant difference in the other key perioperative outcomes such as operating time, length of stay, postoperative morbidity, major morbidity and 90-day mortality between both groups.

Conclusion

R-LLS was associated with similar key perioperative outcomes compared to L-LLS. It was also associated with significantly lower blood loss and open conversion rates compared to L-LLS.

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Acknowledgements

Collaborators for the International robotic and laparoscopic liver resection study group investigators: Chung-Yip Chan (Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore), Celine De Meyere (Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium), Diana Salimgereeva (Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia), Ruslan Alikhanov (Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia), Lip-Seng Lee (Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital, Singapore), Jae Young Jang (Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea), Roberto Montalti (Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, Federico II University Hospital Naples, Naples, Italy).

Funding

Dr T. P. Kingham was partially supported by the US National Cancer Institute MSKCC Core Grant number P30 CA008747 for this study.

Author information

Authors and Affiliations

  1. Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital & National Cancer Centre Singapore, Level 5, 20 College Road, Academia, Singapore, 169856, Singapore

    Yvette Chong, Brian K. P. Goh & Chung-Yip Chan

  2. Duke-National University Singapore Medical School, Singapore, Singapore

    Yvette Chong, Brian K. P. Goh & Chung-Yip Chan

  3. Hepatobiliary Surgery and Liver Transplantation Unit, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Bilbao, Spain

    Mikel Prieto & Mikel Gastaca

  4. Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea

    Sung-Hoon Choi & Jae Young Jang

  5. Digestive Health Institute, AdventHealth Tampa, Tampa, FL, USA

    Iswanto Sucandy

  6. Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital, Singapore, Singapore

    Adrian K. H. Chiow & Lip-Seng Lee

  7. General Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy

    Marco V. Marino

  8. General Surgery Department, F. Tappeiner Hospital, Merano, Italy

    Marco V. Marino

  9. Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China

    Xiaoying Wang

  10. Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia

    Mikhail Efanov, Diana Salimgereeva & Ruslan Alikhanov

  11. Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium

    Henri Schotte, Mathieu D’Hondt & Celine De Meyere

  12. Division of Hepatopancreatobiliary Surgery, Department of Surgery, Severance Hospital, , Yonsei University College of Medicine, Seoul, Korea

    Gi-Hong Choi

  13. Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, and Berlin Institute of Health, Berlin, Germany

    Felix Krenzien, Moritz Schmelzle & Johann Pratschke

  14. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    T. Peter Kingham

  15. Division of HPB, Minimally Invasive and Robotic Surgery, Department of Clinical Medicine and Surgery, Federico II University Hospital Naples, Naples, Italy

    Mariano Giglio, Roberto I. Troisi & Roberto Montalti

  16. Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Jae Hoon Lee

  17. Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China

    Eric C. Lai & Chung Ngai Tang

  18. Department of Digestive, Oncologic and Metabolic Surgery, Institute Mutualiste Montsouris, Universite Paris Descartes, Paris, France

    David Fuks

  19. Department of Surgery, Seoul National University Hospital Bundang, Seoul National University College of Medicine, Seoul, Korea

    Mizelle D’Silva & Ho-Seong Han

  20. Department of Hepatopancreatobiliary and Liver Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

    Prashant Kadam & Robert P. Sutcliffe

  21. Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China

    Kit-Fai Lee & Charing C. Chong

  22. Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China

    Tan-To Cheung

  23. Faculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China

    Qiu Liu & Rong Liu

Authors
  1. Yvette Chong
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  2. Mikel Prieto
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  3. Mikel Gastaca
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  32. Brian K. P. Goh
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Consortia

International robotic and laparoscopic liver resection study group investigators

  • Chung-Yip Chan
  • , Celine De Meyere
  • , Diana Salimgereeva
  • , Ruslan Alikhanov
  • , Lip-Seng Lee
  • , Jae Young Jang
  •  & Roberto Montalti

Corresponding author

Correspondence to Brian K. P. Goh.

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Disclosures

Dr Brian Goh has received travel grants and honorarium from Johnson and Johnson, Olympus and Transmedic the local distributor for the Da Vinci Robot. Dr Marco Marino is a consultant for CAVA robotics LLC. Johann Pratschke reports a research grant from Intuitive Surgical Deutschland GmbH and personal fees or non-financial support from Johnson & Johnson, Medtronic, AFS Medical, Astellas, CHG Meridian, Chiesi, Falk Foundation, La Fource Group, Merck, Neovii, NOGGO, pharma-consult Peterson, and Promedicis. Moritz Schmelzle reports personal fees or other support outside of the submitted work from Merck, Bayer, ERBE, Amgen, Johnson & Johnson, Takeda, Olympus, Medtronic, Intuitive. Drs Chong Y, Prieto M, Gastaca M, Choi SH, Sucandy I, Chiow AK, Wang X, Efanov M, Schotte H, D’Hondt M, Choi GH, Krenzien F, Kingham TP, Giglio M, Troisi RI, Lee JH, Lai EC, Tang CN, Fuks D, D’Silva M, Han HS, Kadam P, Sutcliffe RP, Lee KF, Chong CC, Cheung TT, Liu Q and Liu R have no conflicts of interests and financial ties to disclose.

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International robotic and laparoscopic liver resection study group investigators are listed in acknowledgement section.

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Chong, Y., Prieto, M., Gastaca, M. et al. An international multicentre propensity score matched analysis comparing between robotic versus laparoscopic left lateral sectionectomy. Surg Endosc 37, 3439–3448 (2023). https://doi.org/10.1007/s00464-022-09790-x

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