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Robotic versus laparoscopic resections of posterosuperior segments of the liver : a propensity score-matched comparison

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Abstract
Background: Open parenchymal-preserving resection is the current standard of care for lesions in the posterosuperior liver segments. Laparoscopy and robot-assisted surgery are emergent surgical approaches for liver resections, even in posteriorly located lesions. The objective of this study was to compare robot-assisted to laparoscopic parenchymal-preserving liver resections for lesions located in segments 7, 8, 4a, and 1. Methods: Demographics, comorbidities, clinicopathologic characteristics, surgical treatments, and outcomes from patients who underwent laparoscopic and robot-assisted liver resection in two centers for lesions in the posterosuperior segments between June 2008 and February 2014 were reviewed. A 1: 2 matched propensity score analysis was performed by individually matching patients in the robotic cohort to patients in the laparoscopic cohort based on demographics, comorbidities, performance status, tumor stage, location, and type of resection. Results: Thirty-six patients who underwent robot-assisted liver resection were matched with 72 patients undergoing laparoscopic liver resection. Matched patients displayed no significant differences in postoperative outcomes as measured by blood loss, hospital stay, R0 negative margin rate, and mortality. The overall morbidity according to the comprehensive complication index was also similar (34.6 +/- 33 vs. 18.4 +/- 11.3, respectively, for robotic and laparoscopic approach, p = 0.11). Patients undergoing robotic liver surgery had significantly longer inflow occlusion time (77 vs. 25 min, p = 0.001) as compared with their laparoscopic counterparts. Conclusions: Although number and severity of complications in the robotic group appears to be higher, robotic and laparoscopic parenchymal-preserving liver resections in the posterosuperior segments display similar safety and feasibility.
Keywords
Robotic liver resections, posterosuperior segments, Laparoscopic liver resections, Propensity score, HEPATOCELLULAR-CARCINOMA, HEPATIC RESECTION, SURGERY, HEPATECTOMY, FEASIBILITY, METASTASES, TUMORS, ULTRASONOGRAPHY, EXPERIENCE, OUTCOMES

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MLA
Montalti, Roberto et al. “Robotic Versus Laparoscopic Resections of Posterosuperior Segments of the Liver : a Propensity Score-matched Comparison.” SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES 30.3 (2016): 1004–1013. Print.
APA
Montalti, R., SCUDERI, V., Patriti, A., Vivarelli, M., & Troisi, R. (2016). Robotic versus laparoscopic resections of posterosuperior segments of the liver : a propensity score-matched comparison. SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 30(3), 1004–1013.
Chicago author-date
Montalti, Roberto, VINCENZO SCUDERI, Alberto Patriti, Marco Vivarelli, and Roberto Troisi. 2016. “Robotic Versus Laparoscopic Resections of Posterosuperior Segments of the Liver : a Propensity Score-matched Comparison.” Surgical Endoscopy and Other Interventional Techniques 30 (3): 1004–1013.
Chicago author-date (all authors)
Montalti, Roberto, VINCENZO SCUDERI, Alberto Patriti, Marco Vivarelli, and Roberto Troisi. 2016. “Robotic Versus Laparoscopic Resections of Posterosuperior Segments of the Liver : a Propensity Score-matched Comparison.” Surgical Endoscopy and Other Interventional Techniques 30 (3): 1004–1013.
Vancouver
1.
Montalti R, SCUDERI V, Patriti A, Vivarelli M, Troisi R. Robotic versus laparoscopic resections of posterosuperior segments of the liver : a propensity score-matched comparison. SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES. 2016;30(3):1004–13.
IEEE
[1]
R. Montalti, V. SCUDERI, A. Patriti, M. Vivarelli, and R. Troisi, “Robotic versus laparoscopic resections of posterosuperior segments of the liver : a propensity score-matched comparison,” SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, vol. 30, no. 3, pp. 1004–1013, 2016.
@article{7046830,
  abstract     = {{Background: Open parenchymal-preserving resection is the current standard of care for lesions in the posterosuperior liver segments. Laparoscopy and robot-assisted surgery are emergent surgical approaches for liver resections, even in posteriorly located lesions. The objective of this study was to compare robot-assisted to laparoscopic parenchymal-preserving liver resections for lesions located in segments 7, 8, 4a, and 1. 
Methods: Demographics, comorbidities, clinicopathologic characteristics, surgical treatments, and outcomes from patients who underwent laparoscopic and robot-assisted liver resection in two centers for lesions in the posterosuperior segments between June 2008 and February 2014 were reviewed. A 1: 2 matched propensity score analysis was performed by individually matching patients in the robotic cohort to patients in the laparoscopic cohort based on demographics, comorbidities, performance status, tumor stage, location, and type of resection. 
Results: Thirty-six patients who underwent robot-assisted liver resection were matched with 72 patients undergoing laparoscopic liver resection. Matched patients displayed no significant differences in postoperative outcomes as measured by blood loss, hospital stay, R0 negative margin rate, and mortality. The overall morbidity according to the comprehensive complication index was also similar (34.6 +/- 33 vs. 18.4 +/- 11.3, respectively, for robotic and laparoscopic approach, p = 0.11). Patients undergoing robotic liver surgery had significantly longer inflow occlusion time (77 vs. 25 min, p = 0.001) as compared with their laparoscopic counterparts. 
Conclusions: Although number and severity of complications in the robotic group appears to be higher, robotic and laparoscopic parenchymal-preserving liver resections in the posterosuperior segments display similar safety and feasibility.}},
  author       = {{Montalti, Roberto and SCUDERI, VINCENZO and Patriti, Alberto and Vivarelli, Marco and Troisi, Roberto}},
  issn         = {{0930-2794}},
  journal      = {{SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES}},
  keywords     = {{Robotic liver resections,posterosuperior segments,Laparoscopic liver resections,Propensity score,HEPATOCELLULAR-CARCINOMA,HEPATIC RESECTION,SURGERY,HEPATECTOMY,FEASIBILITY,METASTASES,TUMORS,ULTRASONOGRAPHY,EXPERIENCE,OUTCOMES}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{1004--1013}},
  title        = {{Robotic versus laparoscopic resections of posterosuperior segments of the liver : a propensity score-matched comparison}},
  url          = {{http://dx.doi.org/10.1007/s00464-015-4284-9}},
  volume       = {{30}},
  year         = {{2016}},
}

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