The Clinical Comparative Study Of Da Vinci Robot,Laparoscope And Open Right Liver Tumor Resection In Short-term Efficacy

Objective:The purpose of this study was to explore the short-term efficacy of Da Vinci robot,laparoscopy and laparotomy for the resection of hepatocellular carcinoma of the right liver,and to provide a certain basis for providing appropriate surgical methods for different clinical patients.Methods:1.Data of inpatients with primary hepatocellular carcinoma of the right liver in The Affiliated Hospital of Qingdao University from January 2016 to December 2019 were collected.Including preoperative patients with general information(including gender,age,height,weight,preoperative liver function index and grade of anesthesia ASA,tumor size,whether the range of liver cirrhosis,surgical resection),intraoperative situation(including the operation time,intraoperative blood loss,blood transfusion amount,liver door blocking rate,etc.),the postoperative situation(including the length of hospital stay,postoperative complications,postoperative 1,3-day liver function index),hospitalization costs and complications.2.According to different surgical methods,patients were divided into Da Vinci robot group(RLR),laparoscopic group(LLR)and open group(OLR).The perioperative situation of patients in the three groups was compared using statistical software.3.Due to differences in tumor size and resection scope among different groups,the matched patients were compared after bias matching.4.The collected patients were followed up for 2 years,and the 2-year recurrence rate of patients in the three groups was compared.In addition,patients undergoing VI segment surgery were separately analyzed in the perioperative period of the three groups.Results:Before matching,the three groups of patients showed gender,age,whether there were complications(hypertension,type 2 diabetes)and body mass index(BMI),preoperative liver function indexes(alanine aminotransferase,aspartate aminotransferase,total bilirubin,albumin,prothrombin time),ASA grade,cirrhosis or not had no significant differences(P > 0.05),tumor diameter and subtotal hepatectomy had significant differences(P < 0.05).RLR group,LLR group and OLR group were 1:2: 2 after matching,there was no significant difference at baseline level.Results there were no significant differences in bleeding,blood transfusion,complications and WBC on postoperative day 1,ALT,AST and albumin on postoperative day 1 and 3 among the three groups(P > 0.05).In terms of operation time,RLR group and LLR group were longer than OLR group(P < 0.05),and there was no significant difference between RLR group and LLR group(P > 0.05).The liver blocking rate in RLR group was higher than that in OLR group(P < 0.05).Total bilirubin in OLR group was significantly higher than that in RLR group and LLR group(P < 0.05).The length of postoperative hospital stay in RLR group was short than that in OLR group(P < 0.05),but no significant difference was found between RLR group and LLR group.The total hospitalization cost in RLR group was higher than that in LLR group and OLR group(P < 0.05).There was no significant difference in 2-year tumor recurrence rate among OLR,LLR and RLR groups(P > 0.05),and the total hospitalization cost in RLR group was higher than that in LLR group and OLR group(P < 0.05),but there was no significant difference in other indicators(P >0.05).Conclusion:In conclusion,Da Vinci robot has similar short-term efficacy and 2-year tumor recurrence rate with laparotomy and laparoscopy.Robot surgery has faster postoperative recovery,but longer operation time and higher cost.For patients with good economic conditions,Da Vinci robotic right liver surgery may be a better choice.