Comparison of perioperative outcomes between robot-assisted and laparoscopic hepatectomy for hepatic tumors

doi:10.3877/cma.j.issn.1674-6899.2025.02.006

Abstract

Abstract:

Objective

To compare the perioperative efficacy of da Vinci robot and laparoscopic partial hepatectomy in the treatment of hepatic tumors.

Method

Retrospective analysis was conducted on a cohort of 184 patients with hepatic tumors who underwent partial hepatectomy at the Department of Hepatobiliary Pacreatic Surgery and the Second Department of Hepatobiliary Surgery, Guangzhou First People's Hospital, between Jan. 2021 and Jun. 2023. This cohort comprised two groups: the robot group (n=52) consisting of patients who underwent robotic-assisted partial hepatectomy, and the laparoscope group(n=132) comprising patients who underwent laparoscopic partial hepatectomy. The perioperative status of the robot group was assessed, and a comparison of surgical-related indicators and postoperative complications between the two groups was conducted using propensity score matching.

Results

The average operative time for the robotic surgery group at our center was 177 (145-243.8) minutes. After completing 20 cases,surgeons can begin to navigate the learning curve, with operation time progressively stabilizing. Upon accumulating 42 cases, they can gradually transition into the proficiency phase. After propensity score matching, there were no statistically significant differences in baseline variables such as age, gender, and tumor location between the robotic surgery group and the laparoscopic surgery group (P>0.05). Compared to the laparoscopic surgery group, the robotic surgery group demonstrated significantly shorter operative time for right partial hepatectomy (P=0.0002) and reduced intraoperative blood loss (P=0.006). However,there were no statistically significant differences observed in postoperative hospital stay, postoperative complication rate, postoperative blood transfusion, and duration of antibiotic use (P>0.05).

Conclusion

Laparoscopic and robotic partial hepatectomy with the da Vinci robot are both safe and effective for the treatment of hepatic tumors. Robotic partial hepatectomy for right-sided hepatic tumors has a shorter operation time and less blood loss than laparoscopic partial hepatectomy.

Key words: Hepatic tumors, da Vinci robot, Laparoscope, Propensity score matching, Safety, Effectiveness

Yujie Xu, Xuefeng Hua, Ning Li, Minqiang Lu. Comparison of perioperative outcomes between robot-assisted and laparoscopic hepatectomy for hepatic tumors[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2025, 18(02): 98-104.

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Figures/Tables 7

References 21

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类别	数据特征
年龄(岁)	54. 17±14. 94
性别[例(%)]
男	32(61. 5)
女	20(38. 5)
肿瘤位置[例(%)]
左肝	24(46. 2)
右肝	26(50. 0)
左右肝均有	2(3. 8)
肿瘤直径(cm)	4(2～6)
累及门静脉及其分支[例(%)]	2(3. 8)
恶性肿瘤[例(%)]	36(69. 2)
手术时长(min)	177(145～243. 8)
左侧手术时间	167. 5(140. 5～235)
右侧手术时间	179. 5(148. 8～245. 8)
左右联合手术时间	252. 5(215～290)
术中出血量(ml)	50(35～100)
术中补液量(ml)	2　300(1　713～2　775)
术后住院天数(d)	7(5～8. 75)
术后出血[例(%)]	1(1. 9)
术后胆瘘[例(%)]	2(3. 8)
术后发热[例(%)]	9(17. 3)
术后抗生素使用天数(d)	4. 5(3. 25～6)

类别	数据特征
年龄(岁)	54. 17±14. 94
性别[例(%)]
男	32(61. 5)
女	20(38. 5)
肿瘤位置[例(%)]
左肝	24(46. 2)
右肝	26(50. 0)
左右肝均有	2(3. 8)
肿瘤直径(cm)	4(2～6)
累及门静脉及其分支[例(%)]	2(3. 8)
恶性肿瘤[例(%)]	36(69. 2)
手术时长(min)	177(145～243. 8)
左侧手术时间	167. 5(140. 5～235)
右侧手术时间	179. 5(148. 8～245. 8)
左右联合手术时间	252. 5(215～290)
术中出血量(ml)	50(35～100)
术中补液量(ml)	2　300(1　713～2　775)
术后住院天数(d)	7(5～8. 75)
术后出血[例(%)]	1(1. 9)
术后胆瘘[例(%)]	2(3. 8)
术后发热[例(%)]	9(17. 3)
术后抗生素使用天数(d)	4. 5(3. 25～6)

	倾向性匹配前				倾向性匹配后
	机器人组(n =52)	腹腔镜组(n =132)	统计量	P值	机器人组(n =51)	腹腔镜组(n =90)	统计量	P值
年龄(岁)^a	54. 17±14. 94	58. 65±12. 93	2. 023	0. 045	54. 14±15. 09	58. 44±13. 20	1. 767	0. 079
性别[例(%)]^b				0. 221				0. 455
男	32(61. 5)	94(71. 2)			32(62. 7)	63(70. 0)
女	20(38. 5)	38(28. 8)			19(37. 3)	27(30. 0)
肿瘤位置[例(%)]^b				0. 035				0. 863
左肝	24(46. 2)	41(31. 0)			23(45. 1)	35(38. 9)
右肝	26(50. 0)	71(53. 8)			26(51. 0)	51(56. 7)
左右肝均有	2(3. 8)	20(15. 2)			2(3. 9)	4(4. 4)
肿瘤直径(cm)^c	4(2～6)	4(2～6)	3　307	0. 698	4(2～6)	4(3～6)	2068	0. 327
是否累及门静脉及其分支[例(%)]^b				0. 676				0. 129
是	2(3. 8)	4(3. 0)			2(3. 9)	0(0)
否	50(96. 2)	128(97. 0)			49(96. 1)	90(100)
是否恶性肿瘤[例(%)]^b				0. 461				0. 701
是	36(69. 2)	99(75. 0)			35(68. 6)	65(72. 2)
否	16(30. 8)	33(25. 0)			16(31. 4)	25(27. 8)

	倾向性匹配前				倾向性匹配后
	机器人组(n =52)	腹腔镜组(n =132)	统计量	P值	机器人组(n =51)	腹腔镜组(n =90)	统计量	P值
年龄(岁)^a	54. 17±14. 94	58. 65±12. 93	2. 023	0. 045	54. 14±15. 09	58. 44±13. 20	1. 767	0. 079
性别[例(%)]^b				0. 221				0. 455
男	32(61. 5)	94(71. 2)			32(62. 7)	63(70. 0)
女	20(38. 5)	38(28. 8)			19(37. 3)	27(30. 0)
肿瘤位置[例(%)]^b				0. 035				0. 863
左肝	24(46. 2)	41(31. 0)			23(45. 1)	35(38. 9)
右肝	26(50. 0)	71(53. 8)			26(51. 0)	51(56. 7)
左右肝均有	2(3. 8)	20(15. 2)			2(3. 9)	4(4. 4)
肿瘤直径(cm)^c	4(2～6)	4(2～6)	3　307	0. 698	4(2～6)	4(3～6)	2068	0. 327
是否累及门静脉及其分支[例(%)]^b				0. 676				0. 129
是	2(3. 8)	4(3. 0)			2(3. 9)	0(0)
否	50(96. 2)	128(97. 0)			49(96. 1)	90(100)
是否恶性肿瘤[例(%)]^b				0. 461				0. 701
是	36(69. 2)	99(75. 0)			35(68. 6)	65(72. 2)
否	16(30. 8)	33(25. 0)			16(31. 4)	25(27. 8)

	机器人组(n =51)	腹腔镜组(n =90)	统计量	P值
中转开腹[例(%)] ^a				0. 553
是	0(0)	3(3. 3)
否	51(100)	87(96. 7)
手术时长(min)^b	179(145～245)	244(182. 3～358. 8)	1 491	0. 0005
左侧手术时间	170(140～245)	213(138～271)	331	0. 259
右侧手术时间	179(148～245. 8)	295(205～405)	330. 5	0. 0002
左右联合手术时间	252. 5(215～290)	176(165. 8～308. 5)	2	0. 533
术中出血量(ml)^b	50(30～100)	100(50～300)	1　664	0. 006
术中补液量(ml)^b	2　300(1　700～2　800)	3　000(2　300～3　675)	1　351	＜0. 0001
术后住院天数(d)^b	7(5～9)	7(6～11)	2　080	0. 355

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