Published online Jan 27, 2022. doi: 10.4254/wjh.v14.i1.224
Peer-review started: March 26, 2021
First decision: November 11, 2021
Revised: December 2, 2021
Accepted: December 25, 2021
Article in press: December 25, 2021
Published online: January 27, 2022
Liver surgery has traditionally been characterized by the complexity of its procedures and potentially high rates of morbidity and mortality in inexperienced hands. The robotic approach has gradually been introduced in liver surgery and has increased notably in recent years. However, few centers currently perform robotic liver surgery and experiences in robot-assisted surgical procedures continue to be limited compared to the laparoscopic approach.
To analyze the outcomes and feasibility of an initial robotic liver program implemented in an experienced laparoscopic hepatobiliary center.
A total of forty consecutive patients underwent robotic liver resection (da Vinci Xi, intuitive.com, United States) between June 2019 and January 2021. Patients were prospectively followed and retrospectively reviewed. Clinicopathological characteristics and perioperative and short-term outcomes were analyzed. Data are expressed as mean and standard deviation. The study was approved by the Institutional Review Board.
The mean age of patients was 59.55 years, of which 18 (45%) were female. The mean body mass index was 29.41 kg/m². Nine patients (22.5%) were cirrhotic. Patients were divided by type of resection as follows: Ten segmentectomies, three wedge resections, ten left lateral sectionectomies, six bisegmentectomies (two V-VI bisegmentectomies and four IVb-V bisegmentectomies), two right anterior sectionectomies, five left hepatectomies and two right hepatectomies. Malignant lesions occurred in twenty-nine (72.5%) of the patients. The mean operative time was 258.11 min and two patients were transfused intraoperatively (5%). Inflow occlusion was used in thirty cases (75%) and the mean total clamping time was 32.62 min. There was a single conversion due to uncontrollable hemorrhage. Major postoperative complications (Clavien–Dindo > IIIb) occurred in three patients (7.5%) and mortality in one (2.5%). No patient required readmission to the hospital. The mean hospital stay was 5.6 d.
Although robotic hepatectomy is a safe and feasible procedure with favorable short-term outcomes, it involves a demanding learning curve that requires a high level of training, skill and dexterity.
Core Tip: The number of liver procedures performed laparoscopically remains highly variable, ranging from 10% up to 80% in some centers, and complex hepatectomies are still confined to expert and experienced laparoscopic liver surgeons. The robotic approach is gradually being introduced in liver surgery and has increased notably in recent years, which could compensate for the inherent difficulties of the laparoscopic approach. In this study, we analyzed our single-center data of robotic liver resections using the da Vinci Xi System®.