Robotic-Assisted Hepatic Resection: A Systematic Review of Mortality and Morbidity

Jean-sébastien Pelletier, MD FRCSC, Richdeep Gill, MD, Xinzhe Shi, MPH, Daniel Birch, MD MSc FRCSC, Shahzeer Karmali, MD FRCSC. University of Alberta, Centre for he Advancement of Minimally Invasive Surgery

Introduction:

Minimally invasive surgery continues to evolve and be integrated into increasingly complex surgical procedures. Currently, segmental hepatic resection are being performed with robotic systems. However, there is a paucity of evidence regarding potential advantages and outcomes of these procedures compared to either the open or laparoscopic approaches. The aim of this study is to systematic review the mortality and morbidity related to robotic-assisted hepatic resections for benign and malignant disease.
 

Methods:

A search of electronic databases, MEDLINE, PubMed, Embase, Scopus, Dare, Clinical Evidence, TRIP, Health Technology Database, Conference abstracts, clinical trials, and the Cochrane Library database was completed. The search terms used included robotic, robot, telerobotic, telerobot, computer assisted, computer aided, da Vinci, hepatectomy, pancreatectomy and pancreaticoduodenectomy. All human studies, limited to adults, that had been published between 2000 to August 2010 were included.

Results:

After an initial screen of 3672 titles, 158 abstracts were reviewed, and 19 studies met the inclusion criteria. After full-manuscript review, a total of 7 studies were included with a total of 171 procedures. The overall morbidity rate was 12.3% (range 0-43%) based on seven studies. There were no mortalities reported following robotic-assisted hepatic resection. Mean operative time was 260 minutes, with a mean hospital length of stay of 7.8 days. Rate of conversion to either conventional laparoscopic or open surgery was 2.5%. Cost was only reported in one study, however was greater than either laparoscopy or open hepatic surgery.
 

Conclusions:

Despite limited evidence, our systematic review suggests robotic-assisted hepatic resection is safe and feasible, with low mortality and morbidity rates. However, further research is needed to determine if oncological outcomes are similar. Furthermore, increased costs seems to continue to be a deterrent.
 

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