"Laparoscopic and robotic techniques have both been well adopted as safe options in selected patients undergoing hepatectomy. However, it is unknown whether either approach is superior, especially for major hepatectomy such as right hepatectomy or extended right hepatectomy (RH/ERH)," the study team says in JAMA Surgery.
Dr. Brian Goh of Singapore General Hospital and colleagues did a propensity-score-matched analysis of patients undergoing robotic or laparoscopic RH/EHR at 29 international centers from 2008 to 2020, with 220 in each group.
They found that robotic RH/ERH was associated with a lower open conversion rate (8.6% vs. 17.7%, P=0.01) and slightly shorter postoperative hospital stay (mean 9.11 vs. 9.94 days, P=0.048) when compared with laparoscopic RH/ERH.
To minimize the confounding effect of the learning curve (50 cases for laparoscopic and 25 cases for robotic liver resection), the researchers did a separate analysis that only included cases after centers had met the learning curve.
In this analysis, length of stay was still shorter for the robotic approach, but there was no longer a statistical difference in the rate of conversion to open hepatectomy, owing to improvement over time in the laparoscopic group.
This implies that the robotic approach may be associated with a "shorter learning curve" and "may help to overcome the learning curve in RH/ERH at the initial phase," Dr. Goh and colleagues say.
There were no between-group differences in estimated blood loss, operative time, or perioperative outcomes.
The authors of an invited commentary say the lower rate of conversion to open hepatectomy with the robotic platform is striking.
"With the widespread adoption of minimally invasive surgery over the past decade, the challenge is now in differentiating robotic from laparoscopic surgery," write Dr. Allan Tsung of The Ohio State University Wexner Medical Center, in Columbus, and co-authors.
"Although any surgeon who performs robotic surgery can describe the technical benefits of 7 degrees of freedom, improved visibility, and enhanced ergonomics, the translation of these theoretical advantages into improved patient outcomes has proved difficult," they note.
The current results, which represent the largest series to date of minimally invasive RH/ERH, suggest that "superior outcomes for robotic major hepatectomy can be achieved early in the learning curve, a finding that is corroborated by other studies indicating a steeper learning curve for laparoscopic vs robotic gastrointestinal surgery," they say.
In sum, this study "demonstrates that the robotic platform is not only safe and feasible for major hepatectomies but also provides benefits earlier in the learning curve. Further studies should evaluate whether this advantage translates into added value for the robotic platform for major hepatectomies," Dr. Tsung and co-authors conclude.
The study had no specific funding. The authors report multiple ties to industry.
SOURCE: https://bit.ly/35QAl8R and https://bit.ly/3sYSIRO JAMA Surgery, online March 9, 2022.
By Reuters Staff
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