Minimally Invasive Robot-Assisted Hepatectomy vs. Conventional Laparoscopic Approach: Perioperative Outcomes
Abstract
Background
Robot-assisted hepatectomy offers improved dexterity and visualization in complex liver resections. However, comparative data with conventional laparoscopic hepatectomy in Indian surgical centres is limited, particularly regarding perioperative morbidity and oncological outcomes.
Methods
A prospective comparative study of 89 patients undergoing hepatectomy for hepatocellular carcinoma or colorectal liver metastases from January 2022 to December 2023. Group A (n=44) underwent robot-assisted hepatectomy; Group B (n=45) underwent conventional laparoscopic hepatectomy. Outcomes assessed: operative time, estimated blood loss, conversion rate, postoperative complications (Clavien-Dindo ≥IIIa), and R0 resection rate.
Results
Robot-assisted hepatectomy demonstrated significantly lower estimated blood loss (210 ± 85 mL vs. 340 ± 130 mL; p=0.002), lower conversion rate (4.5% vs. 15.6%; p=0.04), and superior R0 resection rate (97.7% vs. 88.9%; p=0.03). Operative time was longer in the robotic group (285 ± 42 min vs. 218 ± 38 min; p<0.001). 90-day mortality was nil in both groups.
Conclusion
Robot-assisted hepatectomy demonstrates superior perioperative safety profile and oncological margin quality compared to conventional laparoscopy in experienced centres. Longer operative time and higher cost remain considerations for wider adoption.
Conflict of Interest
Dr. Pillai serves on the advisory board of Intuitive Surgical (India). Remaining authors declare no conflicts.