Laparoscopic vs robotic minor liver resection of lesions located in the postero-superior segments: A comparative analysis

Introduction: Laparoscopic liver resection (LLR) is worldwide accepted as safe treatment option for anterior lesions of the liver. The approach of lesions located in the postero-superior (PS) segments (I-IVa-VII-VIII) is more difficult and usually associated to a higher conversion rate and intraoperative complications. It has been speculated that robotic assistance can facilitate the approach to these segments. Method: From 2005 to 2013, 122 minor liver resection were performed in PS segments: 91 of whom with pure laparoscopic approach (LAP-Group) and 31 with robotic assistance (ROB-Group). We analyzed retrospectively data coming from a prospective kept database looking to pre-intra and postoperative parameters in both groups. Results: No perioperative mortality was recorded. Mean age was of 58.6 15.6 vs. 63.7 12.7 years, respectively (p = 0.12), male rate was 54.9% vs. 61.3% (p = 0.68). Contemporaneous colic resection was performed in 4.4 vs. 22.6% (p = 0.006). Type of resection were: bisegmentectomy in 19% and 16%; monosegmentectomy 24% and 16%; wedge 37% and 42%; mixed 20% and 26%, respectively for Lap and ROB (p = 0.8). Previous liver resection were 11% vs. 7.4% (p = 0.73), mean surgical time 286 103 vs. 301 135 minutes (p = 0.54), blood loss 292 404 vs. 380 381 cc (p = 0.35) respectively. Pringle maneuver was 13.2% vs. 58.1% respectively for LAP and ROB (p < 0.01). Conversion rate was 11% vs. 16.1% (0.53). Histology revealed that the mean nodules number was of 1.6 0.9 vs. 1.9 1.3 (p = 0.2), total lesions dimension was of 44.4 28.2 vs. 42.9 31.1 mm (p = 0.8) and R1 margins 15% vs. 11% (p = 0.55). Overall complication rate was of 18.2 vs. 14.8% (p = 0.6), mean hospital stay 5.6 4.1 vs. 8.6 8 days (p = 0.01). Conclusions: Pure laparoscopic and robotic liver resections for lesions located in PS segments have a similar outcome and conversion rate. A trend for higher blood losses could be related to differences in operative techniques and resection devices (surgical aspirator in LAP vs. crush clamping technique in ROB)