Outpatient and Ambulatory Extended Recovery Robotic Hepatectomy: Multinational Study of 307 Cases

Author:

Park James O1,Lafaro Kelly2,Hagendoorn Jeroen3,Melstrom Laleh4,Gerhards Michael F5,Görgec Burak6,Marsman Hendrik A5,Thornblade Lucas W7,Pilz da Cunha Gabriela6,Yang Frank F1,Labadie Kevin P1,Sham Jonathan G1,Swijnenburg Rutger-Jan6,He Jin2,Fong Yuman4

Affiliation:

1. From the Division of General Surgery, University of Washington, Seattle, WA (Park, Yang, Labadie, Sham)

2. Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Lafaro, He)

3. Department of Surgical Oncology, University Medical Center, Utrecht, The Netherlands (Hagendoorn)

4. Department of Surgery, City of Hope National Medical Center, Duarte, CA (Melstrom, Fong).

5. Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands (Gerhards, Marsman)

6. Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands (Görgec, Pilz da Cunha, Swijnenburg)

7. Department of Surgical Oncology, University of California San Fransisco, San Fransisco, CA (Thornblade)

Abstract

BACKGROUND: For open minor hepatectomy, morbidity and recovery are dominated by the incision. The robotic approach may transform this “incision dominant procedure” into a safe outpatient procedure. STUDY DESIGN: We audited outpatient (less than 2 midnights) robotic hepatectomy at 6 hepatobiliary centers in 2 nations to test the hypothesis that the robotic approach can be a safe and effective short-stay procedure. Establishing early recovery after surgery programs were active at all sites, and home digital monitoring was available at 1 of the institutions. RESULTS: A total of 307 outpatient (26 same-day and 281 next-day discharge) robotic hepatectomies were identified (2013 to 2023). Most were minor hepatectomies (194 single segments, 90 bi-segmentectomies, 14 three segments, and 8 four segments). Thirty-nine (13%) were for benign histology, whereas 268 were for cancer (33 hepatocellular carcinoma, 27 biliary, and 208 metastatic disease). Patient characteristics were a median age of 60 years (18 to 93 years), 55% male, and a median BMI of 26 kg/m2 (14 to 63 kg/m2). Thirty (10%) patients had cirrhosis. One hundred eighty-seven (61%) had previous abdominal operation. Median operative time was 163 minutes (30 to 433 minutes), with a median blood loss of 50 mL (10 to 900 mL). There were no deaths and 6 complications (2%): 2 wound infections, 1 failure to thrive, and 3 perihepatic abscesses. Readmission was required in 5 (1.6%) patients. Of the 268 malignancy cases, 25 (9%) were R1 resections. Of the 128 with superior segment resections (segments 7, 8, 4A, 2, and 1), there were 12 positive margins (9%) and 2 readmissions for abscess. CONCLUSIONS: Outpatient robotic hepatectomy in well-selected cases is safe (0 mortality, 2% complication, and 1.6% readmission), including resection in the superior or posterior portions of the liver that is challenging with nonarticulating laparoscopic instruments.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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