Robotic Versus Laparoscopic Liver Resection: A Nationwide Propensity Score Matched Analysis
Objective:. To compare nationwide outcomes of robotic liver resection (RLR) with laparoscopic liver resection (LLR). Background:. Minimally invasive liver resection is increasingly performed using the robotic approach as this could help overcome inherent technical limitations of laparoscopy. It is u...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Health
2024-12-01
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| Series: | Annals of Surgery Open |
| Online Access: | http://journals.lww.com/10.1097/AS9.0000000000000527 |
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| author | Gabriela Pilz da Cunha, MD Jasper P. Sijberden, MD, PhD Susan van Dieren, PhD Paul Gobardhan, MD, PhD Daan J. Lips, MD, PhD Türkan Terkivatan, MD, PhD Hendrik A. Marsman, MD, PhD Gijs A. Patijn, MD, PhD Wouter K. G. Leclercq, MD, PhD Koop Bosscha, MD, PhD J. Sven D. Mieog, MD, PhD Peter B. van den Boezem, MD, PhD Maarten Vermaas, MD, PhD Niels F. M. Kok, MD, PhD Eric J. T. Belt, MD, PhD Marieke T. de Boer, MD, PhD Wouter J. M. Derksen, MD, PhD Hans Torrenga, MD, PhD Paul M. Verheijen, MD, PhD Steven J. Oosterling, MD, PhD Arjen M. Rijken, MD, PhD Marielle M. E. Coolsen, MD, PhD Mike S. L. Liem, MD, PhD T.C. Khé Tran, MD, PhD Michael F. Gerhards, MD, PhD Vincent Nieuwenhuijs, MD, PhD Mohammad Abu Hilal, MD, PhD Marc G. Besselink, MD, PhD Ronald M. van Dam, MD, PhD Jeroen Hagendoorn, MD, PhD Rutger-Jan Swijnenburg, MD, PhD for the Dutch Hepatobiliary Audit Group |
| author_facet | Gabriela Pilz da Cunha, MD Jasper P. Sijberden, MD, PhD Susan van Dieren, PhD Paul Gobardhan, MD, PhD Daan J. Lips, MD, PhD Türkan Terkivatan, MD, PhD Hendrik A. Marsman, MD, PhD Gijs A. Patijn, MD, PhD Wouter K. G. Leclercq, MD, PhD Koop Bosscha, MD, PhD J. Sven D. Mieog, MD, PhD Peter B. van den Boezem, MD, PhD Maarten Vermaas, MD, PhD Niels F. M. Kok, MD, PhD Eric J. T. Belt, MD, PhD Marieke T. de Boer, MD, PhD Wouter J. M. Derksen, MD, PhD Hans Torrenga, MD, PhD Paul M. Verheijen, MD, PhD Steven J. Oosterling, MD, PhD Arjen M. Rijken, MD, PhD Marielle M. E. Coolsen, MD, PhD Mike S. L. Liem, MD, PhD T.C. Khé Tran, MD, PhD Michael F. Gerhards, MD, PhD Vincent Nieuwenhuijs, MD, PhD Mohammad Abu Hilal, MD, PhD Marc G. Besselink, MD, PhD Ronald M. van Dam, MD, PhD Jeroen Hagendoorn, MD, PhD Rutger-Jan Swijnenburg, MD, PhD for the Dutch Hepatobiliary Audit Group |
| author_sort | Gabriela Pilz da Cunha, MD |
| collection | DOAJ |
| description | Objective:. To compare nationwide outcomes of robotic liver resection (RLR) with laparoscopic liver resection (LLR).
Background:. Minimally invasive liver resection is increasingly performed using the robotic approach as this could help overcome inherent technical limitations of laparoscopy. It is unknown if this translates to improved patient outcomes.
Methods:. Data from the mandatory Dutch Hepatobiliary Audit were used to compare perioperative outcomes of RLR and LLR in 20 centers in the Netherlands (2014–2022). Propensity score matching (PSM) was used to mitigate selection bias. Sensitivity analyses assessed the impact of the learning curve (≥50 procedures for LLR and ≥25 procedures for RLR), concurrent noncholecystectomy operations, high-volume centers, and conversion on outcomes.
Results:. Overall, 792 RLR and 2738 LLR were included. After PSM (781 RLR vs 781 LLR), RLR was associated with less blood loss (median: 100 mL [interquartile range (IQR): 50–300] vs 200 mL [IQR: 50–500], P = 0.002), less major blood loss (≥500 mL,18.6% vs 25.2%, P = 0.011), less conversions (4.9% vs 12.8%, P < 0.001), and shorter hospital stay (median: 3 days [IQR: 2–5] vs 4 days [IQR: 2–6], P < 0.001), compared with LLR. There were no significant differences in overall and severe morbidity, readmissions, mortality, and R0 resection rate. Sensitivity analyses yielded similar results. When excluding conversions, RLR was only associated with a reduction in reoperations (1.1% vs 2.7%, P = 0.038).
Conclusion:. In this nationwide analysis, RLR was associated with a reduction in conversion, blood loss and length of hospital stay without compromising patient safety, also when excluding a learning curve effect. The benefits of RLR seem to be mostly related to a reduction in conversions. |
| format | Article |
| id | doaj-art-f898a840e4b34c07865a1451fdbb1c19 |
| institution | Kabale University |
| issn | 2691-3593 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Wolters Kluwer Health |
| record_format | Article |
| series | Annals of Surgery Open |
| spelling | doaj-art-f898a840e4b34c07865a1451fdbb1c192025-01-24T09:18:58ZengWolters Kluwer HealthAnnals of Surgery Open2691-35932024-12-0154e52710.1097/AS9.0000000000000527202412000-00033Robotic Versus Laparoscopic Liver Resection: A Nationwide Propensity Score Matched AnalysisGabriela Pilz da Cunha, MD0Jasper P. Sijberden, MD, PhD1Susan van Dieren, PhD2Paul Gobardhan, MD, PhD3Daan J. Lips, MD, PhD4Türkan Terkivatan, MD, PhD5Hendrik A. Marsman, MD, PhD6Gijs A. Patijn, MD, PhD7Wouter K. G. Leclercq, MD, PhD8Koop Bosscha, MD, PhD9J. Sven D. Mieog, MD, PhD10Peter B. van den Boezem, MD, PhD11Maarten Vermaas, MD, PhD12Niels F. M. Kok, MD, PhD13Eric J. T. Belt, MD, PhD14Marieke T. de Boer, MD, PhD15Wouter J. M. Derksen, MD, PhD16Hans Torrenga, MD, PhD17Paul M. Verheijen, MD, PhD18Steven J. Oosterling, MD, PhD19Arjen M. Rijken, MD, PhD20Marielle M. E. Coolsen, MD, PhD21Mike S. L. Liem, MD, PhD22T.C. Khé Tran, MD, PhD23Michael F. Gerhards, MD, PhD24Vincent Nieuwenhuijs, MD, PhD25Mohammad Abu Hilal, MD, PhD26Marc G. Besselink, MD, PhD27Ronald M. van Dam, MD, PhD28Jeroen Hagendoorn, MD, PhD29Rutger-Jan Swijnenburg, MD, PhD30for the Dutch Hepatobiliary Audit Group* Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands* Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands* Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands§ Department of Surgery, Amphia Medical Center, Breda, The Netherlands‖ Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands¶ Department of Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands# Department of Surgery, OLVG, Amsterdam, The Netherlands** Department of Surgery, Isala, Zwolle, The Netherlands†† Department of Surgery, Maxima Medisch Centrum, Veldhoven, The Netherlands‡‡ Department of Surgery, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands§§ Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands‖‖ Department of Surgery, Radboud Medical Center, Nijmegen, The Netherlands¶¶ Department of Surgery, Ijsselland Hospital, Capelle aan den Ijssel, The Netherlands## Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands*** Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands††† Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands‡‡‡ Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands‖‖‖ Department of Surgery, Deventer Ziekenhuis, Deventer, The Netherlands¶¶¶ Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands### Department of Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands§ Department of Surgery, Amphia Medical Center, Breda, The Netherlands**** Department of Surgery, Maastricht UMC, Maastricht, The Netherlands.‖ Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands¶ Department of Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands# Department of Surgery, OLVG, Amsterdam, The Netherlands** Department of Surgery, Isala, Zwolle, The Netherlands‡ Department of Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy* Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands**** Department of Surgery, Maastricht UMC, Maastricht, The Netherlands.§§ Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands* Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The NetherlandsObjective:. To compare nationwide outcomes of robotic liver resection (RLR) with laparoscopic liver resection (LLR). Background:. Minimally invasive liver resection is increasingly performed using the robotic approach as this could help overcome inherent technical limitations of laparoscopy. It is unknown if this translates to improved patient outcomes. Methods:. Data from the mandatory Dutch Hepatobiliary Audit were used to compare perioperative outcomes of RLR and LLR in 20 centers in the Netherlands (2014–2022). Propensity score matching (PSM) was used to mitigate selection bias. Sensitivity analyses assessed the impact of the learning curve (≥50 procedures for LLR and ≥25 procedures for RLR), concurrent noncholecystectomy operations, high-volume centers, and conversion on outcomes. Results:. Overall, 792 RLR and 2738 LLR were included. After PSM (781 RLR vs 781 LLR), RLR was associated with less blood loss (median: 100 mL [interquartile range (IQR): 50–300] vs 200 mL [IQR: 50–500], P = 0.002), less major blood loss (≥500 mL,18.6% vs 25.2%, P = 0.011), less conversions (4.9% vs 12.8%, P < 0.001), and shorter hospital stay (median: 3 days [IQR: 2–5] vs 4 days [IQR: 2–6], P < 0.001), compared with LLR. There were no significant differences in overall and severe morbidity, readmissions, mortality, and R0 resection rate. Sensitivity analyses yielded similar results. When excluding conversions, RLR was only associated with a reduction in reoperations (1.1% vs 2.7%, P = 0.038). Conclusion:. In this nationwide analysis, RLR was associated with a reduction in conversion, blood loss and length of hospital stay without compromising patient safety, also when excluding a learning curve effect. The benefits of RLR seem to be mostly related to a reduction in conversions.http://journals.lww.com/10.1097/AS9.0000000000000527 |
| spellingShingle | Gabriela Pilz da Cunha, MD Jasper P. Sijberden, MD, PhD Susan van Dieren, PhD Paul Gobardhan, MD, PhD Daan J. Lips, MD, PhD Türkan Terkivatan, MD, PhD Hendrik A. Marsman, MD, PhD Gijs A. Patijn, MD, PhD Wouter K. G. Leclercq, MD, PhD Koop Bosscha, MD, PhD J. Sven D. Mieog, MD, PhD Peter B. van den Boezem, MD, PhD Maarten Vermaas, MD, PhD Niels F. M. Kok, MD, PhD Eric J. T. Belt, MD, PhD Marieke T. de Boer, MD, PhD Wouter J. M. Derksen, MD, PhD Hans Torrenga, MD, PhD Paul M. Verheijen, MD, PhD Steven J. Oosterling, MD, PhD Arjen M. Rijken, MD, PhD Marielle M. E. Coolsen, MD, PhD Mike S. L. Liem, MD, PhD T.C. Khé Tran, MD, PhD Michael F. Gerhards, MD, PhD Vincent Nieuwenhuijs, MD, PhD Mohammad Abu Hilal, MD, PhD Marc G. Besselink, MD, PhD Ronald M. van Dam, MD, PhD Jeroen Hagendoorn, MD, PhD Rutger-Jan Swijnenburg, MD, PhD for the Dutch Hepatobiliary Audit Group Robotic Versus Laparoscopic Liver Resection: A Nationwide Propensity Score Matched Analysis Annals of Surgery Open |
| title | Robotic Versus Laparoscopic Liver Resection: A Nationwide Propensity Score Matched Analysis |
| title_full | Robotic Versus Laparoscopic Liver Resection: A Nationwide Propensity Score Matched Analysis |
| title_fullStr | Robotic Versus Laparoscopic Liver Resection: A Nationwide Propensity Score Matched Analysis |
| title_full_unstemmed | Robotic Versus Laparoscopic Liver Resection: A Nationwide Propensity Score Matched Analysis |
| title_short | Robotic Versus Laparoscopic Liver Resection: A Nationwide Propensity Score Matched Analysis |
| title_sort | robotic versus laparoscopic liver resection a nationwide propensity score matched analysis |
| url | http://journals.lww.com/10.1097/AS9.0000000000000527 |
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