M Fruscione, MD, MBA, E Baker, MD, A Cochran, MSPH, J Martinie, MD, FACS, D Vrochides, MD, PhD, FACS, FRCSC, D Iannitti, MD, FACS. Carolinas Medical Center
Objective: Questions of superiority and cost-effectiveness of robot-assisted compared with laparoscopic approach to hepatectomy remain unanswered. To understand outcomes and challenges of each, we reviewed published reports and conducted cost-benefit analyses for major hepatectomy performed at a high-volume hepatopancreatobiliary surgery center.
Methods: Reports of minimally invasive hepatectomy published from 2008 to 2016 were reviewed. Patient data, operative characteristics, and outcomes were compared between robot-assisted and laparoscopic approaches. A retrospective analysis was conducted of patients who underwent minimally invasive major hepatectomy (≥3 segments) at our center from 2008–2016 (n = 181). Patient data, operative characteristics, and outcomes were compared between robot-assisted (n = 57) and laparoscopic (n = 124) hepatectomy.
Results: Published reports of both approaches demonstrated similar perioperative characteristics and post-operative outcomes; however, a paucity of data precludes any valid conclusion on superiority or relative cost-effectiveness. Patients undergoing robot-assisted versus laparoscopic major hepatectomy at our center were older (58.1 ± 15.7 versus 53.1 ± 15.6 years, respectively; p = 0.029), went to the ICU post-operatively less often (46.3% versus 62.8%, respectively; p = 0.041), and were readmitted less often within 90 days (5.3% versus 20.2%, respectively; p = 0.010). No significant differences were found between groups for blood loss volume, operative times, transfusion volume, and length of stay. Mean total cost was not significantly different between the robot-assisted versus laparoscopic approach ($31,732 versus $27,053, respectively; p = 0.057).
Conclusion: Robot-assisted hepatectomy is safe, feasible, and effective with no significant cost differential compared to laparoscopic hepatectomy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78816
Program Number: P698
Presentation Session: Poster (Non CME)
Presentation Type: Poster
