Laparoscopic versus robotic major hepatectomy: a systematic review and meta-analysis
- 1 February 2021
- journal article
- review article
- Published by Springer Science and Business Media LLC in Surgical Endoscopy
- Vol. 35 (2), 524-535
- https://doi.org/10.1007/s00464-020-08008-2
Abstract
Background The implementation of the laparoscopic and robotic approaches for major hepatectomy (LMH and RMH) was slower than that for minor hepatectomy, but has significantly increased over the past years. The role or advantages of RMH remains controversial, and we aimed to compare the peri-/postoperative outcomes of LMH versus RMH. Methods A systematic literature review was conducted using the MEDLINE and Cochrane Library databases according to the PRISMA guidelines (end-of-search date: March 16th, 2020). Only comparative studies (LMH vs. RMH) reporting on outcomes of interest were included. Meta-analysis was performed using the random-effects model when substantial heterogeneity was encountered; otherwise, the fixed-effects model was implemented. Quality of evidence assessment was performed using the Newcastle-Ottawa Scale. Results Seven retrospective cohort studies comparing LMH (n = 300) versus RMH (n = 225) were identified. No significant difference was observed between LMH and RMH regarding overall complications [odds ratio (OR) 1.42, 95% confidence interval (CI) 0.90-2.23;p = 0.13], severe complications (Clavien-Dindo grade >= 3) [risk difference (RD) 0.01, 95% CI - 0.03 to 0.05;p = 0.72], and overall mortality (RD 0.00, 95% CI - 0.02 to 0.03;p = 0.73). The two approaches were also equivalent regarding conversion to open hepatectomy (RD 0.03, 95% CI - 0.01 to 0.08;p = 0.15), margin-positive resection (OR 1.34, 95% CI 0.51-3.52;p = 0.55), and transfusion rate (RD - 0.03, 95% CI - 0.16 to 0.11;p = 0.67). No significant difference was observed for LMH versus RMH regarding blood loss [standardized mean difference (SMD) 0.27, 95% CI - 0.24 to 0.77;p = 0.30), operative time (SMD - 0.08, 95% CI - 0.51 to 0.34;p = 0.70), and length of stay (SMD 0.13, 95% CI - 0.58 to 0.84;p = 0.72). Conclusion LMH and RMH have equivalent peri-/postoperative outcomes when performed in select patients and high-volume centers.This publication has 77 references indexed in Scilit:
- Minimally Invasive Liver Resection: Robotic Versus Laparoscopic Left Lateral SectionectomyJournal of Gastrointestinal Surgery, 2012
- Robotic versus laparoscopic resection of liver tumoursHPB, 2010
- The International Position on Laparoscopic Liver SurgeryAnnals of Surgery, 2009
- World Review of Laparoscopic Liver Resection—2,804 PatientsAnnals of Surgery, 2009
- Laparoscopic versus open left lateral hepatic sectionectomy: A comparative studyEuropean Journal of Surgical Oncology, 2008
- Evaluation of 300 Minimally Invasive Liver Resections at a Single InstitutionAnnals of Surgery, 2007
- Laparoscopic Left Lateral Sectionectomy in Living DonorsAnnals of Surgery, 2006
- Robotics in General SurgeryArchives of Surgery, 2003
- The separation of DPN-linked and TPN-linked isocitrate dehydrogenase activities of mammalian liverBiochemical and Biophysical Research Communications, 1967