Short-Term Outcomes After Robotic Versus Open Liver Resection: A Systematic Review and Meta-analysis

3D visualization systems improve operator efficiency during difficult laparoscopic cholecystectomy: a retrospective blinded review of surgical videos

BACKGROUND

3D visualization systems in laparoscopic surgery have been proposed to improve manual task handling compared to 2D, however, few studies have compared the intra-operative efficacy in laparoscopic cholecystectomy (LC). The aim of this study is to determine if there is a benefit in intra-operative efficiency when using a 3D visualization system in difficult LC compared to traditional 2D visualization systems.

METHODS

Retrospective analysis of 'difficult' LCs (Grades 3 or 4) was completed. The assessor was blinded as all cases were recorded and viewed in 2D only. Variables collected included time to complete steps, missed hook diathermy attempts, failed grasp attempts, missed clip attempts and preparation steps for intra-operative cholangiogram (IOC). Multiple linear regression was undertaken for time variables, Poisson regression or negative binomial regression was completed for continuous variables.

RESULTS

Fifty-two operative videos of 'difficult' LC were reviewed. 3D systems were associated with reduced operative times, although this was not statistically significant (CI: -2.93-14.93, P-value = 0.183). Dissection of the anterior fold to achieve the critical view of safety was significantly faster by 3.55 min (CI: 1.215-9.206, P-value = 0.002), and with considerably fewer errors when using 3D systems. Fewer IOC preparation errors were observed with a 3D system compared with a 2D system.

CONCLUSIONS

3D systems appear to enhance operator efficiency, allowing faster completion of critical steps with fewer errors. This pilot study underscores the utility of video annotation for intra-operative assessment and suggests that, in larger multi-centre studies, 3D systems may demonstrate superior intra-operative efficiency over 2D systems during a 'difficult' LC.

Comparative study of operative expenses: robotic vs. laparoscopic vs. open liver resections at a university hospital in the UK

Robotic liver resections (RLR) are increasingly being performed and has previously been considered more costly. The aim is to explore the cost of RLR compared with laparoscopic and open liver resection in a single National Health Service (NHS) hospital. A retrospective review of patients who underwent RLR, LLR, and OLR from April 2014 to December 2022 was conducted. The primary outcomes were the cost of consumables and median income, and the secondary outcomes were the overall length of stay and mortality at 90 days. Overall, 332 patients underwent liver resections. There were 204 males (61.4%) and 128 females (38.6%), with a median age of 62 years (IQR: 51-77 years). Of these, 60 patients (18.1%) underwent RLR, 21 patients (6.3%) underwent LLR, and 251 patients (75.6%) underwent OLR. Median consumables cost per case was £3863 (IQR: £3458-£5061) for RLR, £4326 (IQR: £4273-£4473) for LLR, and £4,084 (IQR: £3799-£5549) for the OLR cohort (p = 0.140). Median income per case was £7999 (IQR: £4509-£10,777) for RLR, £7497 (IQR: £2407-£14,576) for LLR, and £7493 (IQR: £2542-£14,121) for OLR. The median length of stay (LOS) for RLR was 3 days (IQR: 2-4.7 days) compared to 5 days for LLR (IQR: 4.5-7 days) and 6 days for OLR (IQR: 5-8 days, p < 0.001). Within the NHS, RLR has consumable costs comparable to OLR and LLR. It is also linked with a shorter LOS and generates similar income for patients undergoing OLR and LLR.

Prince and princesses: The current status of robotic surgery in surgical oncology

Robotic surgery has experienced a dramatic increase in utilization across general surgery over the last two decades, including in surgical oncology. Although urologists and gynecologists were the first to show that this technology could be utilized in cancer surgery, the robot is now a powerful tool in the treatment of gastrointestinal, hepato-pancreatico-biliary, colorectal, endocrine, and soft tissue malignancies. While long-term outcomes are still pending, short-term outcomes have showed promise for this technologic advancement of cancer surgery.

Robotic hepatectomy: current evidence and future directions

Minimally invasive hepatectomy continues to gain popularity and acceptance for treatment of benign and malignant liver disease. Robotic hepatectomy offers potential advantages over open and conventional laparoscopic approaches. Review of the literature on robotic hepatectomy was performed. Search terms included "robotic hepatectomy" and "minimally invasive hepatectomy." Search was further customized to include articles related to robotic surgical technology. Across many parameters in liver surgery, robotic liver resection appears to have comparable outcomes with respect to laparoscopic resection. The benefits over open resection are largely related to less morbidity and faster recovery times. There is evidence that the robotic approach may have a shorter learning curve and enable more difficult resections to be performed minimally invasively. The robotic platform may have the potential to achieve superior margin status or parenchymal sparing resection in oncologic resections, but numerous obstacles remain. The robotic platform has not been applied to liver surgery to the same extent as either laparoscopic or open surgery. Robotic surgical technology will need to continue developing to deliver on its potential advantages.

Implementation of a patient blood management in an Italian City Hospital: is it effective in reducing the use of red blood cells?

To evaluate the effect of patient blood management (PBM) since its introduction, we analyzed the need for transfusion and the outcomes in patients undergoing abdominal surgery for different types of tumor pre- and post-PBM. Patients undergoing elective gastric, liver, pancreatic, and colorectal surgery between 2017 and 2020 were included. The implementation of the PBM program was completed on May 1, 2018. The patients were grouped as follows: those who underwent surgery before the implementation of the program (pre-PBM) versus after the implementation (post-PBM). A total of 1302 patients were included in the analysis (445 pre-PBM vs. 857 post-PBM). The number of transfused patients per year decreased significantly after the introduction of PBM. A strong tendency for a decreased incidence of transfusion was evident in gastric and pancreatic surgery and a similar decrease was statistically significant in liver surgery. With regard to gastric surgery, a single-unit transfusion scheme was used more frequently in the post-PBM group (7.7% vs. 55% after PBM; p = 0.049); this was similar in liver surgery (17.6% vs. 58.3% after PBM; p = 0.04). Within the subgroup of patients undergoing liver surgery, a significant reduction in the use of blood transfusion (20.5% vs. 6.7%; p = 0.002) and a decrease in the Hb trigger for transfusion (8.5, 8.2-9.5 vs. 8.2, 7.7-8.4 g/dl; p = 0.039) was reported after the PBM introduction. After the implementation of a PBM protocol, a significant reduction in the number of patients receiving blood transfusion was demonstrated, with a strong tendency to minimize the use of blood products for most types of oncologic surgery.