title: Robotic liver surgery for minor hepatic resections: a comparison with laparoscopic and open standard procedures.
abstract: BACKGROUND
  Minimally invasive liver surgery is increasing worldwide. The benefit of the robot in this scenario is currently controversially discussed. We compared our robotic cases vs. laparoscopic and open minor hepatic resections and share the experience.
  
  
  METHODS
  From 2011 to 2015, ten patients underwent robotic and 19 patients underwent laparoscopic minor liver resections in the Department of Surgery, University Hospital Erlangen. These patients were compared to a case-matched control group of 53 patients. The perioperative prospectively collected data were analyzed retrospectively.
  
  
  RESULTS
  Blood loss was significantly decreased in the robotic (306 ml) and laparoscopic (356 ml) vs. the open (903 ml) surgery group (p = 0.001). Mean tumor size was 4.1-4.8 cm in all groups (p = 0.571). Negative surgical margins were present in 94 % of the open and 100 % of the laparoscopic and robotic group (p = 0.882). Time for surgery was enlarged for robotic (321 min) vs. laparoscopic (242 min) and open (186 min) surgery (p = 0.001). Postoperative hospitalization was decreased after robotic (7 days) and laparoscopic (8 days) vs. open (10 days) surgery (p = 0.004). Total morbidity was 17 % for open, 16 % for laparoscopic, and 1 % for robotic cases (p = 0.345). Postoperative pain medication and elevation of liver enzymes were remarkably lower after minimally invasive vs. open procedures.
  
  
  CONCLUSIONS
  Minimally invasive liver surgery can be performed safely for minor hepatic resections and should be considered whenever possible. Minor liver resections can be performed by standard laparoscopy equivalent to robotic procedures. Nevertheless, the robot adds a technical upgrade which may have benefits for challenging cases and major liver surgery.
authors.affiliation: Department of Surgery, Liver Center, University Hospital Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany. Roland.Croner@uk-erlangen.de.
authors.forename: Roland S
authors.initials: RS
authors.lastname: Croner
authors.affiliation: Department of Surgery, Liver Center, University Hospital Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany.
authors.forename: Aristotiles
authors.initials: A
authors.lastname: Perrakis
authors.affiliation: Department of Surgery, Liver Center, University Hospital Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Hohenberger
authors.affiliation: Department of Surgery, Liver Center, University Hospital Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany.
authors.forename: Maximillian
authors.initials: M
authors.lastname: Brunner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D002277:Carcinoma / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D016896:Treatment Outcome
keywords: Colorectal cancer; HCC; Liver malignancy; Liver surgery; Minimally invasive surgery; Robotic surgery