title: Robot-assisted laparoscopic liver resection: a systematic review and pooled analysis of minor and major hepatectomies.
abstract: BACKGROUND
  Robotic surgery has been introduced to overcome the limitations of conventional laparoscopy. A systematic review and meta-analysis were performed to assess the safety and feasibility for three subgroups of robot-assisted laparoscopic liver resection: (i) minor resections of easily accessible segments: 2/3, 4B, 5, 6, (ii) minor resections of difficult located segments: 1, 4A, 7, 8 and (iii) major resections: ≥ 4 segments.
  
  
  METHODS
  A systematic search was performed in PubMed, EMBASE and Cochrane Library.
  
  
  RESULTS
  Twelve observational, mostly retrospective studies reporting on 363 patients were included. Data were pooled and analyzed. For subgroup (i) (n = 81) the weighted mean operative time was 215 ± 65 min. One conversion (1%) to laparotomy was needed. Weighted mean operative time for subgroup (ii) (n = 17) was 220 ± 60 min. No conversions were needed. For subgroup (iii) (n = 99) the weighted mean operative time was 405 ± 100 min. In this subgroup 8 robotic procedures (8%) were converted to open surgery.
  
  
  CONCLUSIONS
  Data show that robot-assisted laparoscopic liver resection is feasible in minor resections of all segments and major resections. Larger, prospective studies are warranted to compare the possible advantages of robot-assisted surgery with conventional laparoscopy and open surgery.
authors.affiliation: Department of Surgery, University Medical Center Utrecht, The Netherlands.
authors.forename: Carolijn L
authors.initials: CL
authors.lastname: Nota
authors.affiliation: Department of Surgery, University Medical Center Utrecht, The Netherlands.
authors.forename: Inne H Borel
authors.initials: IHB
authors.lastname: Rinkes
authors.affiliation: Department of Surgery, University Medical Center Utrecht, The Netherlands.
authors.forename: Izaak Q
authors.initials: IQ
authors.lastname: Molenaar
authors.affiliation: Department of Surgery, University Medical Center Utrecht, The Netherlands; Department of Surgery, St. Antonius Ziekenhuis Nieuwegein, The Netherlands.
authors.forename: Hjalmar C
authors.initials: HC
authors.lastname: van Santvoort
authors.affiliation: Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
authors.forename: Yuman
authors.initials: Y
authors.lastname: Fong
authors.affiliation: Department of Surgery, University Medical Center Utrecht, The Netherlands. Electronic address: J.Hagendoorn-3@umcutrecht.nl.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Hagendoorn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D016896:Treatment Outcome; D055815:Young Adult