The Efficacy Of Robotic Versus Laparoscopic Liver Resection:A Comparative Study

Objective:To compare the operative and postoperative outcomes between robotic liver resection and laparoscopic liver resection,evaluate the advantages and defects about robotic liver surgery.Methods:The clinical records of 180 patients underwent minimally invasive liver resection at the Department of General Surgery in Ruijin Hospital from March 2010 to August 2017 were analyzed retrospectively.All patients were divided into two groups according to the different surgery approach,robotic liver resection group(n=45)and laparoscopic liver resection group(n=135).The compared data include gender,age,BMI,ASA class,background of hepatitis infection and cirrhosis,operative outcomes(operative time,intraoperative blood loss,transfusion rate,conversion rate)and post operative outcomes(hospital stay,complication rate and class,mortality rate,R0 resection rate)between two groups.Discontinuous variables were compared using chi-square test and continuous variables were compared using t test,Kaplan-Meier method was adopted for survival analysis,the difference of disease free survival and overall survival between two groups was evaluated by log-rank test.Results :Among the 180 patients who received minimally invasive liver resection,123 were male and 57 were female,the average age was 53.41±12.56 years.There were no significant differences in intraoperative blood loss(422.44±765.66 vs 318.33±385.69 ml,p=0.093),hospital stay(9.04±7.70 vs 7.60±4.16d),transfusion rate(9.8% vs 8.1%,p=0.876),complication rate(26.7% vs 16.3%,p=0.124),mortality rate(0% vs 0%,p=1)and R0 resection rate(100% vs 97.0%,p=0.243)between RLR group and LLR group.Although RLR group is associated with longer operative time(188.67±63.69 vs 135.22±65.02 minutes,p<0.001),the conversion rate is lower(4.4% vs 17.0%,p=0.037)compared with LLR group.Conclusion:Compared with laparoscopic liver resection,robotic liver resection displayed the similarly efficacy,and robotic approach is associated a lower conversion rate.Robotic liver resection is a safe and feasible option for liver resection,and has more advantages than laparoscopic liver resection especially performed on a cirrhosis liver and deep located tumor.