Abstract
Background
Minimally invasive techniques are growing for hepatectomies. Laparoscopic and robotic
liver resections have been shown to differ in conversions. We hypothesize that robotic
approach will have decreased conversion to open and complications despite being a
newer technique than laparoscopy.
Methods
ACS NSQIP study using the targeted Liver PUF from 2014 to 2020. Patients grouped based
on hepatectomy type and approach. Multivariable and propensity scored matching (PSM)
was used to analyze the groups.
Results
Of 7767 patients who underwent hepatectomy, 6834 were laparoscopic and 933 were robotic.
The rate of conversions was significantly lower in robotic vs laparoscopic (7.8% vs
14.7%; p < 0.001). Robotic hepatectomy was associated with decreased conversion for
minor (6.2% vs 13.1%; p < 0.001), but not major, right, or left hepatectomy. Operative
factors associated with conversion included Pringle (OR = 2.09 [95% CI 1.05–4.19];
p = 0.0369), and a laparoscopic approach (OR = 1.96 [95% CI 1.53–2.52]; p < 0.001).
Undergoing conversion was associated with increases in bile leak (13.7% vs 4.9%; p < 0.001),
readmission (11.5% vs 6.1%; p < 0.001), mortality (2.1% vs 0.6%; p < 0.001), length
of stay (5 days vs 3 days; p < 0.001), and surgical (30.5% vs 10.1%; p < 0.001), wound
(4.9% vs 1.5%; p < 0.001) and medical (17.5% vs 6.7%; p < 0.001) complications.
Conclusion
Minimally invasive hepatectomy with conversion is associated with increased complications,
and conversion is increased in the laparoscopic compared to a robotic approach.
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Article info
Publication history
Published online: February 02, 2023
Accepted:
January 30,
2023
Received:
August 7,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.
