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Fabricius M, Ekanem A, Martin AN. Robotic resection for gallbladder cancer: Superior lymphadenectomy does not equal better survival. Surgery 2024; 176:1016-1017. [PMID: 39122593 DOI: 10.1016/j.surg.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 07/05/2024] [Indexed: 08/12/2024]
Affiliation(s)
| | | | - Allison N Martin
- Division of Surgical Oncology, Department of Surgery, Duke University School of Medicine, Durham, NC.
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2
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Lai TJ, Heggie R, Kamaruzaman HF, Bouttell J, Boyd K. Economic Evaluations of Robotic-Assisted Surgery: Methods, Challenges and Opportunities. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024:10.1007/s40258-024-00920-1. [PMID: 39333303 DOI: 10.1007/s40258-024-00920-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/12/2024] [Indexed: 09/29/2024]
Abstract
BACKGROUND The use of robotic-assisted surgery (RAS) is growing rapidly. However, economic evaluation of this technology is challenging. This study aims to identify and discuss the different economic evaluation methods which have been used to evaluate RAS. METHOD This scoping review systematically searched PubMed and Embase from 2015 to 2023. We included economic evaluation studies comparing RAS versus laparoscopic or open surgery. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was used to aid data extraction and was extended to cover additional features relevant to RAS, including learning curve, organisational impact, incremental innovation and dynamic pricing. RESULTS A total of 50 economic evaluations of RAS were included. Cost-utility analysis (46%) was the most commonly applied economic evaluation method, followed by cost-consequence analysis (32%). The studies focused on the specialties of urology (42%), hepato-pancreato-biliary (20%), colorectal (14%) and gynaecology (6%). Distinctive features related to the assessment of RAS were under-addressed in economic evaluations. Only 40% of the included studies considered learning curve and organisational impact and less than 12% of the included studies reflected on incremental innovation and dynamic pricing. CONCLUSIONS This review found that some studies have incorporated challenges specific to RAS in their evaluations. However, most studies still lack key aspects of importance. In particular, studies rarely considered the ability of RAS platforms to be shared across multiple specialities. Incorporating these distinctive features offers an opportunity for economic evaluation to provide decision-makers with a more realistic assessment of the cost-effectiveness of this technology and to ensure its optimal utilisation in clinical practice.
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Affiliation(s)
- Tzu-Jung Lai
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK.
| | - Robert Heggie
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Hanin-Farhana Kamaruzaman
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Malaysian Health Technology Assessment Section (MaHTAS), Medical Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Janet Bouttell
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Centre for Healthcare Equipment and Technology Adoption, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Kathleen Boyd
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Azimuddin AM, Hirata Y, Boyev A, Jain AJ, Ayabe R, Ajith J, Schmeisser JA, Newhook TE, Ikoma N, Tzeng CWD, Chun YS, Vauthey JN, Tran Cao HS. A propensity score matched cost analysis of robotic versus open hepatectomy. HPB (Oxford) 2024:S1365-182X(24)02228-7. [PMID: 39198140 DOI: 10.1016/j.hpb.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 08/02/2024] [Indexed: 09/01/2024]
Abstract
INTRODUCTION Cost-effectiveness of Robotic-assisted hepatectomy compared to the open approach is scrutinized. We compared the costs of robotic versus open hepatectomy at a large cancer center. METHODS Patients undergoing hepatectomy (1/2019-2/2022) were collected from a prospectively maintained database and 1:1 propensity score matched for 61 robotic and 61 open hepatectomy patients by complexity, tumor diagnosis, and age >65. Financial data was collected and converted to a ratio of service cost to average OR cost. Short-term and economic outcomes were compared. RESULTS Median length of stay (2 vs. 3 days), major complication rates (0% vs. 8.2%), and 90-day readmission rates (3.3% vs. 11.5%) were lower for robotic hepatectomy (all p < 0.05). Total 90-day perioperative costs were lower by 19.5% for the robotic cohort (mean 6.89 vs 8.56; p < 0.01). Intraoperative costs were higher in the robotic cohort (mean 2.75 vs. 2.44; p < 0.01). Cost reduction drivers during postoperative care were supplies (mean 0.26 vs. 0.75), laboratory (mean 0.27 vs. 0.49), regular surgery unit (mean 0.19 vs. 0.32), recovery room (mean 0.26 vs. 0.29) and pharmacy cost (median 0.21 vs. 0.32; all p < 0.05). CONCLUSION Hospital costs of robotic hepatectomy were lower than those of open hepatectomy due to significantly reduced postoperative costs.
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Affiliation(s)
- Ahad M Azimuddin
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Texas A&M School of Medicine, Houston, TX, USA
| | - Yuki Hirata
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Artem Boyev
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anish J Jain
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Reed Ayabe
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeeva Ajith
- Financial Planning and Analysis, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jason A Schmeisser
- Financial Planning and Analysis, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Timothy E Newhook
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naruhiko Ikoma
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ching-Wei D Tzeng
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yun-Shin Chun
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hop S Tran Cao
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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4
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Pilz da Cunha G, Coupé VMH, Zonderhuis BM, Bonjer HJ, Erdmann JI, Kazemier G, Besselink MG, Swijnenburg RJ. Healthcare cost expenditure for robotic versus laparoscopic liver resection: a bottom-up economic evaluation. HPB (Oxford) 2024; 26:971-980. [PMID: 38853074 DOI: 10.1016/j.hpb.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/22/2024] [Accepted: 05/27/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Minimally invasive liver surgery (MILS) is increasingly performed via the robot-assisted approach but may be associated with increased costs. This study is a post-hoc comparison of healthcare cost expenditure for robotic liver resection (RLR) and laparoscopic liver resection (LLR) in a high-volume center. METHODS In-hospital and 30-day postoperative healthcare costs were calculated per patient in a retrospective series (October 2015-December 2022). RESULTS Overall, 298 patients were included (143 RLR and 155 LLR). Benefits of RLR were lower conversion rate (2.8% vs 12.3%, p = 0.002), shorter operating time (167 min vs 198 min, p = 0.044), and less blood loss (50 mL vs 200 mL, p < 0.001). Total per-procedure costs of RLR (€10260) and LLR (€9931) were not significantly different (mean difference €329 [95% bootstrapped confidence interval (BCI) €-1179-€2120]). Lower costs with RLR due to shorter surgical and operating room time were offset by higher disposable instrumentation costs resulting in comparable intraoperative costs (€5559 vs €5247, mean difference €312 [95% BCI €-25-€648]). Postoperative costs were similar for RLR (€4701) and LLR (€4684), mean difference €17 [95% BCI €-1357-€1727]. When also considering purchase and maintenance costs, RLR resulted in higher total per-procedure costs. DISCUSSION In a high-volume center, RLR can have similar per-procedure cost expenditure as LLR when disregarding capital investment.
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Affiliation(s)
- Gabriela Pilz da Cunha
- Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Veerle M H Coupé
- Amsterdam UMC, Location University of Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam, the Netherlands
| | - Barbara M Zonderhuis
- Cancer Center Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC, Location Vrije Universiteit, Department of Surgery, Amsterdam, the Netherlands
| | - H Jaap Bonjer
- Cancer Center Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC, Location Vrije Universiteit, Department of Surgery, Amsterdam, the Netherlands
| | - Joris I Erdmann
- Cancer Center Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC, Location Vrije Universiteit, Department of Surgery, Amsterdam, the Netherlands
| | - G Kazemier
- Cancer Center Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC, Location Vrije Universiteit, Department of Surgery, Amsterdam, the Netherlands
| | - Marc G Besselink
- Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Rutger-Jan Swijnenburg
- Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC, Location Vrije Universiteit, Department of Surgery, Amsterdam, the Netherlands.
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5
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Gao F, Zhao X, Xie Q, Jiang K, Mao T, Yang M, Wu H. Comparison of short-term outcomes between robotic and laparoscopic liver resection: a meta-analysis of propensity score-matched studies. Int J Surg 2024; 110:1126-1138. [PMID: 37924495 PMCID: PMC10871648 DOI: 10.1097/js9.0000000000000857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/10/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE This meta-analysis aimed to compare short-term outcomes between robotic liver resection (RLR) and laparoscopic liver resection (LLR) using data collected from propensity score-matched studies. METHODS The PubMed, Cochrane Library, and Embase databases were searched to collect propensity score-matched studies comparing RLR and LLR. Relevant data were extracted and analyzed. Odds ratios (ORs) and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using fixed-effect or random-effect models. Meta-regression analysis was performed for primary outcome measures. Subgroup analyses and sensitivity analyses were performed for outcomes exhibiting high heterogeneity. Quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation framework. RESULTS Twenty-two propensity score-matched studies were included to comprise 5272 patients (RLR group, 2422 cases; LLR group, 2850 cases). Intraoperative blood loss (SMD=-0.31 ml, 95% CI -0.48 to -0.14; P =0.0005), open conversion (OR=0.46, 95% CI 0.37-0.58; P <0.0001), and severe complications (OR=0.76, 95% CI 0.61-0.95; P =0.02) were significantly lower in the RLR group. Operation time, odds of use, and duration of Pringle maneuver, length of hospital stay, and odds of intraoperative blood transfusion, overall complications, R0 resection, reoperation, 30-day readmission, 30-day mortality, and 90-day mortality did not significantly differ between the groups. Further subgroup and sensitivity analyses suggested that the results were stable. Meta-regression analysis did not suggest a correlation between primary outcomes and study characteristics. The quality of evidence for the primary outcomes was medium or low, while that for the secondary outcomes was medium, low, or very low. CONCLUSION Although some short-term outcomes are similar between RLR and LLR, RLR is superior in terms of less blood loss and lower odds of open conversion and severe complications. In the future, RLR may become a safe and effective replacement for LLR.
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Affiliation(s)
- Fengwei Gao
- Liver Transplantation Center, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu
| | - Xin Zhao
- Department of Hepato-Pancreato-Biliary Surgery, The People’s Hospital of Leshan, Leshan
| | - Qingyun Xie
- Department of Hepato-Pancreato-Biliary Surgery, The People’s Hospital of Leshan, Leshan
| | - Kangyi Jiang
- Department of Hepato-Pancreato-Biliary Surgery, The People’s Hospital of Leshan, Leshan
| | - Tianyang Mao
- North Sichuan Medical College, Nanchong, Sichuan, People’s Republic of China
| | - Manyu Yang
- North Sichuan Medical College, Nanchong, Sichuan, People’s Republic of China
| | - Hong Wu
- Liver Transplantation Center, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu
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6
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Balzano E, Bernardi L, Roesel R, Vagelli F, Ghinolfi D, Tincani G, Catalano G, Melandro F, Petrusic A, Popeskou SG, Christoforidis D, Majno-Hurst P, De Simone P, Cristaudi A. Robotic versus laparoscopic liver resections: propensity-matched comparison of two-center experience. Surg Endosc 2023; 37:8123-8132. [PMID: 37721588 DOI: 10.1007/s00464-023-10358-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/30/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND The advantages of the robotic approach in minimally invasive liver surgery (MILS) are still debated. This study compares the short-term outcomes between laparoscopic (LLR) and robotic (RLR) liver resections in propensity score matched cohorts. METHODS Data regarding minimally invasive liver resections in two liver surgery units were retrospectively reviewed. A propensity score matched analysis (1:1 ratio) identified two groups of patients with similar characteristics. Intra- and post-operative outcomes were then compared. The difficulty of MILS was based on the IWATE criteria. RESULTS Two hundred sixty-nine patients underwent MILS between January 2014 and December 2021 (LLR = 192; RLR = 77). Propensity score matching identified 148 cases (LLR = 74; RLR = 74) consisting of compensated cirrhotic patients (100%) underwent non-anatomic resection of IWATE 1-2 class (90.5%) for a solitary tumor < 5 cm in diameter (93.2%). In such patients, RLRs had shorter operative time (227 vs. 250 min, p = 0.002), shorter Pringle's cumulative time (12 vs. 28 min, p < 0.0001), and less blood loss (137 vs. 209 cc, p = 0.006) vs. LLRs. Conversion rate was nihil (both groups). In RLRs compared to LLRs, R0 rate (93 vs. 96%, p > 0.71) and major morbidity (4.1 vs. 5.4%, p > 0.999) were similar, without post-operative mortality. Hospital stay was shorter in the robotic group (6.2 vs. 6.6, p = 0.0001). CONCLUSION This study supports the non-inferiority of RLR over LLR. In compensated cirrhotic patients underwent resection of low-to-intermediate difficulty for a solitary nodule < 5 cm, RLR was faster, with less blood loss despite the shorter hilar clamping, and required shorter hospitalization compared to LLR.
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Affiliation(s)
- Emanuele Balzano
- Hepato-Biliary Surgery and Liver Transplant Unit, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - Lorenzo Bernardi
- Department of Surgery, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Raffaello Roesel
- Department of Surgery, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Filippo Vagelli
- Hepato-Biliary Surgery and Liver Transplant Unit, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Davide Ghinolfi
- Hepato-Biliary Surgery and Liver Transplant Unit, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Giovanni Tincani
- Hepato-Biliary Surgery and Liver Transplant Unit, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Gabriele Catalano
- Hepato-Biliary Surgery and Liver Transplant Unit, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Fabio Melandro
- Hepato-Biliary Surgery and Liver Transplant Unit, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Antonietta Petrusic
- Department of Surgery, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | | | - Dimitri Christoforidis
- Department of Surgery, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Department of Biomedical Sciences, University of Southern Switzerland (USI), Lugano, Switzerland
| | - Pietro Majno-Hurst
- Department of Surgery, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Department of Biomedical Sciences, University of Southern Switzerland (USI), Lugano, Switzerland
| | - Paolo De Simone
- Hepato-Biliary Surgery and Liver Transplant Unit, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
- Department of Surgical, Medical, Biochemical Pathology and Intensive Care, University of Pisa, Pisa, Italy
| | - Alessandra Cristaudi
- Department of Surgery, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Department of Biomedical Sciences, University of Southern Switzerland (USI), Lugano, Switzerland
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Winckelmans T, Wicherts DA, Parmentier I, De Meyere C, Verslype C, D'Hondt M. Robotic Versus Laparoscopic Hepatectomy: A Single Surgeon Experience of 629 Consecutive Minimally Invasive Liver Resections. World J Surg 2023; 47:2241-2249. [PMID: 37208537 DOI: 10.1007/s00268-023-07060-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Robotic surgery has the potential to broaden the indications for minimally invasive liver surgery owing to its technical advantages. This paper compares our experience with robotic liver surgery (RLS) with conventional laparoscopic liver surgery (LLS). METHODS All consecutive liver resections between October 2011 and October 2022 were selected from our prospective database to be included in this cohort study. Patients who underwent RLS were compared with a LLS group for operative and postoperative outcomes. RESULTS In total, 629 patients were selected from our database, including 177 patients who underwent a RLS and 452 patients who had LLS. Colorectal liver metastasis was the main indication for surgery in both groups. With the introduction of RLS, the percentage of open resections decreased significantly (32.6% from 2011 to 2020 vs. 11.5% from 2020 onward, P < 0.001). In the robotic group, redo liver surgery was more frequent (24.3% vs. 16.8%, P = 0.031) and the Southampton difficulty score was higher (4 [IQR 4 to 7] vs. 4 [IQR 3 to 6], P = 0.02). Median blood loss was lower (30 vs. 100 ml, P < 0.001), and postoperative length of stay (LOS) was shorter in the robotic group (median 3 vs. 4 days, P < 0.001). There was no significant difference in postoperative complications. Cost related to the used instruments and LOS was significantly lower in the RLS group (median €1483 vs. €1796, P < 0.001 and €1218 vs. €1624, P < 0.001, respectively), while cost related to operative time was higher (median €2755 vs. €2470, P < 0.001). CONCLUSIONS RLS may allow for a higher percentage of liver resections to be completed in a minimally invasive way with lower blood loss and a shorter LOS.
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Affiliation(s)
- Thomas Winckelmans
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium
| | - Dennis A Wicherts
- Department of Abdominal and Hepatobiliary/Pancreatic Surgery, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Isabelle Parmentier
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium
- Department of Oncology and Statistics, Groeninge Hospital, President Kennedylaan 4, Kortrijk, België
| | - Celine De Meyere
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium
| | - Chris Verslype
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium
- Department of Abdominal and Hepatobiliary/Pancreatic Surgery, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
- Department of Gastroenterology and Hepatology, KU Leuven, Leuven, Belgium
| | - Mathieu D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium.
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Liu R, Abu Hilal M, Wakabayashi G, Han HS, Palanivelu C, Boggi U, Hackert T, Kim HJ, Wang XY, Hu MG, Choi GH, Panaro F, He J, Efanov M, Yin XY, Croner RS, Fong YM, Zhu JY, Wu Z, Sun CD, Lee JH, Marino MV, Ganpati IS, Zhu P, Wang ZZ, Yang KH, Fan J, Chen XP, Lau WY. International experts consensus guidelines on robotic liver resection in 2023. World J Gastroenterol 2023; 29:4815-4830. [PMID: 37701136 PMCID: PMC10494765 DOI: 10.3748/wjg.v29.i32.4815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/22/2023] [Accepted: 08/09/2023] [Indexed: 08/25/2023] Open
Abstract
The robotic liver resection (RLR) has been increasingly applied in recent years and its benefits shown in some aspects owing to the technical advancement of robotic surgical system, however, controversies still exist. Based on the foundation of the previous consensus statement, this new consensus document aimed to update clinical recommendations and provide guidance to improve the outcomes of RLR clinical practice. The guideline steering group and guideline expert group were formed by 29 international experts of liver surgery and evidence-based medicine (EBM). Relevant literature was reviewed and analyzed by the evidence evaluation group. According to the WHO Handbook for Guideline Development, the Guidance Principles of Development and Amendment of the Guidelines for Clinical Diagnosis and Treatment in China 2022, a total of 14 recommendations were generated. Among them were 8 recommendations formulated by the GRADE method, and the remaining 6 recommendations were formulated based on literature review and experts' opinion due to insufficient EBM results. This international experts consensus guideline offered guidance for the safe and effective clinical practice and the research direction of RLR in future.
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Affiliation(s)
- Rong Liu
- Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100000, China
| | - Mohammed Abu Hilal
- Hepatobiliary Pancreatic, Robotic & Laparoscopic Surgery, Poliambulanza Foundation Hospital, Brescia 25100, Italy
| | - Go Wakabayashi
- Center for Advanced Treatment of HBP Diseases, Ageo Central General Hospital, Saitama 362-0075, Japan
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Chinnusamy Palanivelu
- GEM Hospital & Research Centre, GEM Hospital & Research Centre, Coimbatore 641045, India
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa 56126, Italy
| | - Thilo Hackert
- Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg 20251, Germany
| | - Hong-Jin Kim
- Department of Surgery, Yeungnam University Hospital, Daegu 42415, South Korea
| | - Xiao-Ying Wang
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Ming-Gen Hu
- Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100000, China
| | - Gi Hong Choi
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Severance Hospital, Yonsei University, College of Medicine, Seoul 03722, South Korea
| | - Fabrizio Panaro
- Department of Surgery/Division of Robotic and HBP Surgery, Montpellier University Hospital-School of Medicine, Montpellier 34090, France
| | - Jin He
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21218, United States
| | - Mikhail Efanov
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow 111123, Russia
| | - Xiao-Yu Yin
- Department of Pancreatobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
| | - Roland S Croner
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg 39120, Germany
| | - Yu-Man Fong
- Department of Surgery, City of Hope Medical Center, Duarte, CA 91010, United States
| | - Ji-Ye Zhu
- Department of Hepatobiliary Surgery, Peking University People’s Hospital, Beijing 100000, China
| | - Zheng Wu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Chuan-Dong Sun
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Jae Hoon Lee
- Division of Hepatobiliary & Pancreatic surgery, Asan Medical Center, University of Ulsan College of Medicine, Ulsan 682, South Korea
| | - Marco V Marino
- General Surgery Department, F. Tappeiner Hospital, Merano 39012, Italy
| | - Iyer Shridhar Ganpati
- Hepatobiliary and Pancreatic Surgery, National University Hospital, Singapore 189969, Singapore
| | - Peng Zhu
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
| | - Zi-Zheng Wang
- Department of Hepatobiliary Surgery, Senior Department of Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100000, China
| | - Ke-Hu Yang
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Jia Fan
- Zhongshan Hospital, Fudan University, Shanghai 200000, China
| | - Xiao-Ping Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
| | - Wan Yee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
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9
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Shimizu A, Ito M, Lefor AK. Laparoscopic and Robot-Assisted Hepatic Surgery: An Historical Review. J Clin Med 2022; 11:jcm11123254. [PMID: 35743324 PMCID: PMC9225080 DOI: 10.3390/jcm11123254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/28/2022] [Accepted: 06/05/2022] [Indexed: 12/07/2022] Open
Abstract
Hepatic surgery is a rapidly expanding component of abdominal surgery and is performed for a wide range of indications. The introduction of laparoscopic cholecystectomy in 1987 was a major change in abdominal surgery. Laparoscopic surgery was widely and rapidly adopted throughout the world for cholecystectomy initially and then applied to a variety of other procedures. Laparoscopic surgery became regularly applied to hepatic surgery, including segmental and major resections as well as organ donation. Many operations progressed from open surgery to laparoscopy to robot-assisted surgery, including colon resection, pancreatectomy, splenectomy thyroidectomy, adrenalectomy, prostatectomy, gastrectomy, and others. It is difficult to prove a data-based benefit using robot-assisted surgery, although laparoscopic and robot-assisted surgery of the liver are not inferior regarding major outcomes. When laparoscopic surgery initially became popular, many had concerns about its use to treat malignancies. Robot-assisted surgery is being used to treat a variety of benign and malignant conditions, and studies have shown no deterioration in outcomes. Robot-assisted surgery for the treatment of malignancies has become accepted and is now being used at more centers. The outcomes after robot-assisted surgery depend on its use at specialized centers, the surgeon's personal experience backed up by extensive training and maintenance of international registries. Robot-assisted hepatic surgery has been shown to be associated with slightly less intraoperative blood loss and shorter hospital lengths of stay compared to open surgery. Oncologic outcomes have been maintained, and some studies show higher rates of R0 resections. Patients who need surgery for liver lesions should identify a surgeon they trust and should not be concerned with the specific operative approach used. The growth of robot-assisted surgery of the liver has occurred in a stepwise approach which is very different from the frenzy that was seen with the introduction of laparoscopic cholecystectomy. This approach allowed the identification of areas for improvement, many of which are at the nexus of engineering and medicine. Further improvements in robot-assisted surgery depend on the combined efforts of engineers and surgeons.
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Aziz H, Wang JC, Genyk Y, Sheikh MR. Comprehensive analysis of laparoscopic, robotic, and open hepatectomy outcomes using the nationwide readmissions database. J Robot Surg 2021; 16:401-407. [PMID: 34033071 DOI: 10.1007/s11701-021-01257-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/17/2021] [Indexed: 12/11/2022]
Abstract
Although open resections have been the most prevalent method of hepatectomies in the United States, laparoscopic and robotic methods of liver resection have since gained significant traction. Given the augmenting role of minimally invasive techniques in liver resection, a study that explores and analyzes the surgical outcomes of the approaches mentioned above to liver resection on a national basis is warranted. A retrospective analysis was performed in this study using the 2016-2018 Nationwide Readmissions Database (NRD). Patients who underwent liver resections via one of the following methods were selected and grouped: open, laparoscopic, or robotic. Our primary outcome variable of interest was the 45-day readmission rate. 11,186 patients were included in the analysis. The 45-day readmission rate was 13.5%, 12.9%, and 8.7% in the open, laparoscopic, and robotic groups, respectively (p < 0.001). A significantly lower complication rate (7.3%) was seen in the robotic group than its counterparts (11.4% in open vs. 9.1% in the laparoscopic group). Patients undergoing hepatectomies may benefit from the robotic approach given that it is associated with a shorter hospital length of stay and lower readmission rates.
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Affiliation(s)
- Hassan Aziz
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Johnny C Wang
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Yuri Genyk
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Mohd Raashid Sheikh
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA.
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