Experience-based transition to robotic surgery in an experienced program in minimally invasive hepatobiliary surgery.
Hand-assisted liver surgery
Learning curve
Pure laparoscopic liver surgery
Robotic liver surgery
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
15 Oct 2024
15 Oct 2024
Historique:
received:
02
04
2024
accepted:
25
09
2024
medline:
16
10
2024
pubmed:
16
10
2024
entrez:
15
10
2024
Statut:
aheadofprint
Résumé
The adoption of robotic techniques in liver surgery introduces significant challenges for their safe integration within hepatobiliary surgery units. This study is designed to investigate the complexities associated with establishing a robotic surgery program. Data on robotic hepatobiliary surgeries were prospectively collected from October 2021 to October 2023. Historical cohorts from the institutional experiences for comparison were hand-assisted (HALS) and purely laparoscopic procedures (PLS). Inverse probability of treatment weighting and propensity score matching were employed to compare outcomes between PLS and robotic resections. The learning curve for robotic surgeries was evaluated by the cumulative sum method. In this study, 454 patients were enrolled (113 robotic surgeries, 157 HALS, and 184 PLS). The posterosuperior segments resections were significantly higher in the robotic group (47.8%) compared to PLS (31.5%) and HALS (35.7%). There were no conversions in the robotic group, in PLS 2.7% and HALS 3.8%. The degree of difficulty according to the median of the IWATE score and IMM score was significantly higher in the robot group (p < 0.001 and p = 0.008, respectively). No significant differences in short-term outcomes were observed between robotic procedures and PLS in a matched subset of patients. Operative efficiency and blood loss improved significantly after the 75th robotic surgery patient, with high-difficulty cases (IWATE ≥ 10) incorporated from the beginning. This study suggests that robotic liver surgery in units with prior experience in minimally invasive liver surgery offers benefits, such as a lower conversion rate and a higher rate of successful difficult resections.
Sections du résumé
BACKGROUND
BACKGROUND
The adoption of robotic techniques in liver surgery introduces significant challenges for their safe integration within hepatobiliary surgery units. This study is designed to investigate the complexities associated with establishing a robotic surgery program.
METHODS
METHODS
Data on robotic hepatobiliary surgeries were prospectively collected from October 2021 to October 2023. Historical cohorts from the institutional experiences for comparison were hand-assisted (HALS) and purely laparoscopic procedures (PLS). Inverse probability of treatment weighting and propensity score matching were employed to compare outcomes between PLS and robotic resections. The learning curve for robotic surgeries was evaluated by the cumulative sum method.
RESULTS
RESULTS
In this study, 454 patients were enrolled (113 robotic surgeries, 157 HALS, and 184 PLS). The posterosuperior segments resections were significantly higher in the robotic group (47.8%) compared to PLS (31.5%) and HALS (35.7%). There were no conversions in the robotic group, in PLS 2.7% and HALS 3.8%. The degree of difficulty according to the median of the IWATE score and IMM score was significantly higher in the robot group (p < 0.001 and p = 0.008, respectively). No significant differences in short-term outcomes were observed between robotic procedures and PLS in a matched subset of patients. Operative efficiency and blood loss improved significantly after the 75th robotic surgery patient, with high-difficulty cases (IWATE ≥ 10) incorporated from the beginning.
CONCLUSION
CONCLUSIONS
This study suggests that robotic liver surgery in units with prior experience in minimally invasive liver surgery offers benefits, such as a lower conversion rate and a higher rate of successful difficult resections.
Identifiants
pubmed: 39406973
doi: 10.1007/s00464-024-11309-5
pii: 10.1007/s00464-024-11309-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Morise Z (2022) Current status of minimally invasive liver surgery for cancers. World J Gastroenterol 28(43):6090–6098
doi: 10.3748/wjg.v28.i43.6090
pubmed: 36483154
pmcid: 9724486
Zwart MJW, Görgec B, Arabiyat A, Nota CLM, van der Poel MJ, Fichtinger RS et al (2022) Pan-European survey on the implementation of robotic and laparoscopic minimally invasive liver surgery. HPB (Oxford) 24(3):322–331
doi: 10.1016/j.hpb.2021.08.939
pubmed: 34772622
Khan S, Tsung A (2018) ASO author reflections: the evolution of minimally invasive liver surgery and the future with robotics. Ann Surg Oncol 25(Suppl 3):786–787
doi: 10.1245/s10434-018-6880-0
pubmed: 30298328
pmcid: 6333508
Haney CM, Studier-Fischer A, Probst P, Fan C, Müller PC, Golriz M et al (2021) A systematic review and meta-analysis of randomized controlled trials comparing laparoscopic and open liver resection. HPB (Oxford) 23(10):1467–1481
doi: 10.1016/j.hpb.2021.03.006
pubmed: 33820689
Kuemmerli C, Toti JMA, Haak F, Billeter AT, Nickel F, Guidetti C et al (2024) Towards a standardization of learning curve assessment in minimally invasive liver surgery. Ann Surg. https://doi.org/10.1097/SLA.0000000000006417
doi: 10.1097/SLA.0000000000006417
pubmed: 39176477
Lopez-Lopez V, Krürger JAP, Kuemmerli C, Tohme S, Gómez-Gavara C, Iniesta M et al (2023) Long-term oncological outcomes for HALS/Hybrid vs pure laparoscopic approach in colorectal liver metastases: a propensity score matched analysis. Surg Endosc 37(5):3861–3872
doi: 10.1007/s00464-023-09873-3
pubmed: 36710284
Lopez-Lopez V, López-Conesa A, Brusadin R, Perez-Flores D, Navarro-Barrios Á, Gomez-Valles P et al (2022) Pure laparoscopic vs hand-assisted liver surgery for segments 7 and 8: propensity score matching analysis. Surg Endosc 36(6):4470–4478
doi: 10.1007/s00464-021-08800-8
pubmed: 34697682
Wabitsch S, Schöning W, Kästner A, Haber PK, Benzing C, Krenzien F et al (2021) A propensity-matched study of full laparoscopic versus hand-assisted minimal-invasive liver surgery. Surg Endosc 35(5):2021–2028
doi: 10.1007/s00464-020-07597-2
pubmed: 32347389
Abu Hilal M, Aldrighetti L, Dagher I, Edwin B, Troisi RI, Alikhanov R et al (2018) The Southampton consensus guidelines for laparoscopic liver surgery: from indication to implementation. Ann Surg 268(1):11–18
doi: 10.1097/SLA.0000000000002524
pubmed: 29064908
Hobeika C, Pfister M, Geller D, Tsung A, Chan A, Troisi RI et al (2024) Recommendations on robotic Hepato-Pancreato-Biliary Surgery. The Paris Jury-based consensus conference. Ann Surg. https://doi.org/10.1097/SLA.0000000000006365
doi: 10.1097/SLA.0000000000006365
pubmed: 38787528
Krenzien F, Schmelzle M, Pratschke J, Feldbrügge L, Liu R, Liu Q et al (2023) Propensity score-matching analysis comparing robotic versus laparoscopic limited liver resections of the posterosuperior segments: an international multi-center study. Ann Surg. https://doi.org/10.1097/SLA.0000000000006027
doi: 10.1097/SLA.0000000000006027
pubmed: 37485989
Montalti R, Giglio MC, Wu AGR, Cipriani F, D’Silva M, Suhool A et al (2023) Risk factors and outcomes of open conversion during minimally invasive major hepatectomies: an international multicenter study on 3880 procedures comparing the laparoscopic and robotic approaches. Ann Surg Oncol 30(8):4783–4796
doi: 10.1245/s10434-023-13525-0
pubmed: 37202573
Finotti M, D’Amico F, Mulligan D, Testa G (2023) A narrative review of the current and future role of robotic surgery in liver surgery and transplantation. Hepatobiliary Surg Nutr 12(1):56–68
doi: 10.21037/hbsn-21-115
pubmed: 36860258
Rahimli M, Perrakis A, Andric M, Stockheim J, Franz M, Arend J et al (2022) Does robotic liver surgery enhance r0 results in liver malignancies during minimally invasive liver surgery?-A systematic review and meta-analysis. Cancers 14(14):3360
doi: 10.3390/cancers14143360
pubmed: 35884421
pmcid: 9320889
D’Hondt M, Devooght A, Willems E, Wicherts D, De Meyere C, Parmentier I et al (2023) Transition from laparoscopic to robotic liver surgery: clinical outcomes, learning curve effect, and cost-effectiveness. J Robot Surg 17(1):79–88
pubmed: 35322342
Schmelzle M, Feldbrügge L, Ortiz Galindo SA, Moosburner S, Kästner A, Krenzien F et al (2022) Robotic vs. laparoscopic liver surgery: a single-center analysis of 600 consecutive patients in 6 years. Surg Endosc 36(8):5854–5862
doi: 10.1007/s00464-021-08770-x
pubmed: 35641702
pmcid: 9283354
Aboudou T, Li M, Zhang Z, Wang Z, Li Y, Feng L et al (2022) Laparoscopic versus robotic hepatectomy: a systematic review and meta-analysis. J Clin Med. https://doi.org/10.3390/jcm11195831
doi: 10.3390/jcm11195831
pubmed: 36233697
pmcid: 9571364
Rahimli M, Perrakis A, Schellerer V, Gumbs A, Lorenz E, Franz M et al (2020) Robotic and laparoscopic liver surgery for colorectal liver metastases: an experience from a German Academic Center. World J Surg Oncol 18(1):333
doi: 10.1186/s12957-020-02113-1
pubmed: 33353551
pmcid: 7756910
Lin ZY, Zhang XP, Zhao GD, Li CG, Wang ZH, Liu R et al (2023) Short-term outcomes of robotic versus open hepatectomy among overweight patients with hepatocellular carcinoma: a propensity score-matched study. BMC Surg 23(1):153
doi: 10.1186/s12893-023-02058-8
pubmed: 37286991
pmcid: 10246414
Kwak BJ, Lee JH, Chin KM, Syn NL, Choi SH, Cheung TT et al (2023) Robotic versus laparoscopic liver resections for hepatolithiasis: an international multicenter propensity score matched analysis. Surg Endosc 37(8):5855–5864
doi: 10.1007/s00464-023-10051-8
pubmed: 37067594
Zhang XP, Xu S, Hu MG, Zhao ZM, Wang ZH, Zhao GD et al (2022) Short- and long-term outcomes after robotic and open liver resection for elderly patients with hepatocellular carcinoma: a propensity score-matched study. Surg Endosc 36(11):8132–8143
doi: 10.1007/s00464-022-09236-4
pubmed: 35534731
Liu Q, Zhang W, Zhao JJ, Syn NL, Cipriani F, Alzoubi M et al (2023) Propensity-score matched and coarsened-exact matched analysis comparing robotic and laparoscopic major hepatectomies: an international multicenter study of 4822 cases. Ann Surg 278(6):969–975
doi: 10.1097/SLA.0000000000005855
pubmed: 37058429
Robles R, Marín C, Abellán B, López A, Pastor P, Parrilla P (2008) A new approach to hand-assisted laparoscopic liver surgery. Surg Endosc 22(11):2357–2364
doi: 10.1007/s00464-008-9770-x
pubmed: 18322747
Robles Campos R, Marín Hernández C, Lopez-Conesa A, Olivares Ripoll V, Paredes Quiles M, Parrilla PP (2013) Laparoscopic liver resection: lessons learned after 132 resections. Cirugia espanola 91(8):524–533
doi: 10.1016/j.ciresp.2012.11.002
pubmed: 23827926
Robles-Campos R, Lopez-Lopez V, Brusadin R, Lopez-Conesa A, Gil-Vazquez PJ, Navarro-Barrios Á et al (2019) Open versus minimally invasive liver surgery for colorectal liver metastases (LapOpHuva): a prospective randomized controlled trial. Surg Endosc 33(12):3926–3936
doi: 10.1007/s00464-019-06679-0
pubmed: 30701365
Lopez-Lopez V, Sánchez-Esquer I, Crespo MJ, Navarro M, Brusadin R, Conesa AL et al (2022) Development and validation of advanced three-dimensional navigation device integrated in da Vinci Xi® surgical robot for hepatobiliary surgery: pilot study. Br J Surg 110(1):108–110
doi: 10.1093/bjs/znac355
pubmed: 36288540
Tanaka S, Kawaguchi Y, Kubo S, Kanazawa A, Takeda Y, Hirokawa F et al (2019) Validation of index-based IWATE criteria as an improved difficulty scoring system for laparoscopic liver resection. Surgery 165(4):731–740
doi: 10.1016/j.surg.2018.10.012
pubmed: 30446171
Shah J, Vyas A, Vyas D (2014) The history of robotics in surgical specialties. Am J Robotic Surg 1(1):12–20
doi: 10.1166/ajrs.2014.1006
Liu R, Wakabayashi G, Kim HJ, Choi GH, Yiengpruksawan A, Fong Y et al (2019) International consensus statement on robotic hepatectomy surgery in 2018. World J Gastroenterol 25(12):1432–1444
doi: 10.3748/wjg.v25.i12.1432
pubmed: 30948907
pmcid: 6441912
Fukumori D, Tschuor C, Penninga L, Hillingsø J, Svendsen LB, Larsen PN (2023) Learning curves in robot-assisted minimally invasive liver surgery at a high-volume center in Denmark: report of the first 100 patients and review of literature. Scandinavian J Surg 112(3):164–172
doi: 10.1177/14574969221146003
Choi SH, Han DH, Lee JH, Choi Y, Lee JH, Choi GH (2020) Safety and feasibility of robotic major hepatectomy for novice surgeons in robotic liver surgery: a prospective multicenter pilot study. Surg Oncol 35:39–46
doi: 10.1016/j.suronc.2020.07.003
pubmed: 32823088
Labadie KP, Droullard DJ, Lois AW, Daniel SK, McNevin KE, Gonzalez JV et al (2022) IWATE criteria are associated with perioperative outcomes in robotic hepatectomy: a retrospective review of 225 resections. Surg Endosc 36(2):889–895
doi: 10.1007/s00464-021-08345-w
pubmed: 33608766
Guadagni S, Furbetta N, Franco GD, Palmeri M, Gianardi D, Bianchini M et al (2020) Robotic-assisted surgery for colorectal liver metastasis: a single-centre experience. J Minimal Access Surg 16(2):160–165
doi: 10.4103/jmas.JMAS_265_18
Khan S, Beard RE, Kingham PT, Fong Y, Boerner T, Martinie JB et al (2018) Long-term oncologic outcomes following robotic liver resections for primary hepatobiliary malignancies: a multicenter study. Ann Surg Oncol 25(9):2652–2660
doi: 10.1245/s10434-018-6629-9
pubmed: 29987604
pmcid: 6133735
Zheng J, Liang X, Wu AGR, Kabir T, Scatton O, Lim C et al (2023) Impact of liver cirrhosis, severity of cirrhosis and portal hypertension on the difficulty of laparoscopic and robotic minor liver resections for primary liver malignancies in the anterolateral segments. European J Surg Oncol 50(1):107252
doi: 10.1016/j.ejso.2023.107252
Cheung TT, Liu R, Cipriani F, Wang X, Efanov M, Fuks D et al (2023) Robotic versus laparoscopic liver resection for huge (≥10 cm) liver tumors: an international multicenter propensity-score matched cohort study of 799 cases. Hepatobiliary Surg Nutr 12(2):205–215
doi: 10.21037/hbsn-22-283
pubmed: 37124684
pmcid: 10129897
Linn YL, Wu AG, Han HS, Liu R, Chen KH, Fuks D et al (2023) Systematic review and meta-analysis of difficulty scoring systems for laparoscopic and robotic liver resections. J Hepatobiliary Pancreat Sci 30(1):36–59
doi: 10.1002/jhbp.1211
pubmed: 35780493
Berardi G, Aghayan D, Fretland ÅA, Elberm H, Cipriani F, Spagnoli A et al (2019) Multicentre analysis of the learning curve for laparoscopic liver resection of the posterosuperior segments. Br J Surg 106(11):1512–1522
doi: 10.1002/bjs.11286
pubmed: 31441944
Krenzien F, Schmelzle M, Pratschke J, Feldbrügge L, Liu R, Liu Q et al (2024) Propensity score-matching analysis comparing robotic versus laparoscopic limited liver resections of the posterosuperior segments: an international multicenter study. Ann Surg 279(2):297–305
pubmed: 37485989
Yang HY, Rho SY, Han DH, Choi JS, Choi GH (2021) Robotic major liver resections: surgical outcomes compared with open major liver resections. Ann Hepato-Biliary-Pancreatic Surg 25(1):8–17
doi: 10.14701/ahbps.2021.25.1.8
pubmed: 33649249
pmcid: 7952658
Chan FK, Cheng KC, Yeung YP, Ho KM (2016) Learning curve for laparoscopic major hepatectomy: use of the cumulative sum method. Surg Laparosc Endosc Percutaneous Tech 26(3):e41–e45
doi: 10.1097/SLE.0000000000000272
Krenzien F, Benzing C, Feldbrügge L, Ortiz Galindo SA, Hillebrandt K, Raschzok N et al (2022) Complexity-adjusted learning curves for robotic and laparoscopic liver resection: a word of caution. Ann Surg Open 3(1):e131
doi: 10.1097/AS9.0000000000000131
pubmed: 37600114
pmcid: 10431481
Lopez-Lopez V, Esquer IS, Valles PG, Conesa AL, Brusadin R, Navarro A et al (2023) Robotic perihilar cholangiocarcinoma: a step forward in the challenge of minimally invasive liver surgery. Ann Surg Oncol. https://doi.org/10.1245/s10434-023-14613-x4
doi: 10.1245/s10434-023-14613-x4
pubmed: 38071711
pmcid: 10250524