title: Robotic versus laparoscopic resections of posterosuperior segments of the liver: a propensity score-matched comparison.
abstract: BACKGROUND
  Open parenchymal-preserving resection is the current standard of care for lesions in the posterosuperior liver segments. Laparoscopy and robot-assisted surgery are emergent surgical approaches for liver resections, even in posteriorly located lesions. The objective of this study was to compare robot-assisted to laparoscopic parenchymal-preserving liver resections for lesions located in segments 7, 8, 4a, and 1.
  
  
  METHODS
  Demographics, comorbidities, clinicopathologic characteristics, surgical treatments, and outcomes from patients who underwent laparoscopic and robot-assisted liver resection in two centers for lesions in the posterosuperior segments between June 2008 and February 2014 were reviewed. A 1:2 matched propensity score analysis was performed by individually matching patients in the robotic cohort to patients in the laparoscopic cohort based on demographics, comorbidities, performance status, tumor stage, location, and type of resection.
  
  
  RESULTS
  Thirty-six patients who underwent robot-assisted liver resection were matched with 72 patients undergoing laparoscopic liver resection. Matched patients displayed no significant differences in postoperative outcomes as measured by blood loss, hospital stay, R0 negative margin rate, and mortality. The overall morbidity according to the comprehensive complication index was also similar (34.6 ± 33 vs. 18.4 ± 11.3, respectively, for robotic and laparoscopic approach, p = 0.11). Patients undergoing robotic liver surgery had significantly longer inflow occlusion time (77 vs. 25 min, p = 0.001) as compared with their laparoscopic counterparts.
  
  
  CONCLUSIONS
  Although number and severity of complications in the robotic group appears to be higher, robotic and laparoscopic parenchymal-preserving liver resections in the posterosuperior segments display similar safety and feasibility.
authors.affiliation: Department. of Gastroenterology and Transplantation Surgery, Ospedali Riuniti Ancona, Ancona, Italy.|Department. of General and Hepato-Biliary Surgery, Liver Transplantation Service, Ghent University Hospital Medical School, De Pintelaan 185, 2K12 IC, 9000, Ghent, Belgium.
authors.forename: Roberto
authors.initials: R
authors.lastname: Montalti
authors.affiliation: Department. of General and Hepato-Biliary Surgery, Liver Transplantation Service, Ghent University Hospital Medical School, De Pintelaan 185, 2K12 IC, 9000, Ghent, Belgium.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Scuderi
authors.affiliation: Division. of General, Minimally Invasive and Robotic Surgery, General Hospital of Spoleto, Spoleto, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Patriti
authors.affiliation: Department. of Gastroenterology and Transplantation Surgery, Ospedali Riuniti Ancona, Ancona, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Vivarelli
authors.affiliation: Department. of General and Hepato-Biliary Surgery, Liver Transplantation Service, Ghent University Hospital Medical School, De Pintelaan 185, 2K12 IC, 9000, Ghent, Belgium. roberto.troisi@ugent.be.
authors.forename: Roberto I
authors.initials: RI
authors.lastname: Troisi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D057216:Propensity Score; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D055815:Young Adult
keywords: Laparoscopic liver resections; Posterosuperior segments; Propensity score; Robotic liver resections