(HPB P2) Robotic Major Hepatectomy: An Institutional Eexperience and Clinical Outcomes

Introduction: The use of the robotic platform for complex hepatobiliary surgery is increasing. Majority of the literature have only reported outcomes on robotic minor non-anatomical liver resection. This study was undertaken to examine our institutional perioperative outcomes, safety, and feasibly with robotic major liver resection.

Methods: 150 consecutive patients undergoing robotic liver resections were prospectively followed since 2016. Major hepatectomy is defined as a resection of 3 or more segments. For illustrative purposes, data are expressed as median (mean + SD) when appropriate.

Results: Of all patients undergoing robotic liver resections, 85 patients underwent major resection. Median age was 63 years (62±12.8), 46% were women, BMI was 29 (29±6.2) kg/m2 and ASA Class was 3 (3± 0.6). Alcohol use was seen in 12 patients (14%). Of the 85 operations that were undertaken, 30% were for hepatocellular carcinoma, 28% for metastatic adenocarcinoma, 9% for cholangiocarcinoma, and 5% for metastatic neuroendocrine tumor. Regarding the type of resection, 11 patients (13%) had central hepatectomy, 22 patients (25%) had formal right, 23 patients (27%) had formal left, 11 patients (13%) had non-anatomical right, 9 patients (11%) had non-anatomical left, and 9 patients (11%) had posterior superior resection. Prep time (in the room until incision) 58 minutes (62±18.4), Extraction time (incision until specimen extraction) 124 minutes (146±99.5), Console time 198 minutes (210±123.9), Closure time (extraction until dressing placement) 109 minutes (131±93.8), Operative duration was 246 minutes (269±123.2) and time under anesthesia 330 minutes (353±109.6). Estimated blood loss was 200 mL (246±266.3) and length of stay was 4 days (5±4.3). 7 patients experienced postoperative complications (4 ileus, 1 pneumonia, 1bile leak, 1-gram negative bacteremia). 13 patients were readmitted within 30 days with one death after readmission, due to aspiration.

Conclusion: Application of the robotic platform to major liver resection is safe and feasible. Our early experience shows that this minimally invasive approach results in excellent perioperative outcomes.