title: Robotic-Assisted Versus Laparoscopic Left Lateral Sectionectomy: Analysis of Surgical Outcomes and Costs by a Propensity Score Matched Cohort Study.
abstract: After comparing with open approach, left lateral sectionectomy (LLS) has become standard in terms of short-term outcomes without jeopardizing long-term survival when performed for malignancy. The aim of this study was to compare the short-term and economic outcomes of laparoscopic (L-LLS) and robotic (R-LLS) LLS.
  
  
  
  All consecutive patients who underwent L-LLS or R-LLS from 1997 to 2014 were analyzed. Short-term and economic outcomes were compared between the two groups using a propensity score matching (PSM).
  
  
  
  Ninety-six consecutive cases of LLS were performed using the laparoscopic (80 cases; 83 %) or robotic (16 cases; 17 %) approach. The two groups were similar for operative and surgical outcomes. Operation time was similar in the R-LLS compared to the L-LLS group (190 vs. 162 min; p = 0.10). Perioperative costs were higher (1457 € vs. 576 €; p < 0.0001) in the R-LLS group than in the L-LLS group; however, postoperative costs were similar between the two groups (4065 € in the R-LLS group vs. 5459 € in the L-LLS group; p = 0.30). Total costs were similar between the two groups (5522 € in the R-LLS group vs. 6035€ in the L-LLS group; p = 0.70). The PSM included 14 patients for each group. Surgical and economic outcomes remained similar after PSM, except for total operating time which was significantly longer in the R-LLS group than in the L-LLS group.
  
  
  
  Even if feasible and safe, the robotic approach does not seem so far to offer additional benefit in terms of intra- and postoperative outcomes over the laparoscopic approach in patients requiring LLS. Total costs associated with the R-LLS group are not greater than that associated with the L-LLS group, which is the standard of care so far.
authors.affiliation: Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Henri Mondor Hospital, 51 Avenue De Lattre De Tassigny, 94010, Créteil, France.
authors.forename: Chady
authors.initials: C
authors.lastname: Salloum
authors.affiliation: Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Henri Mondor Hospital, 51 Avenue De Lattre De Tassigny, 94010, Créteil, France.
authors.forename: Chetana
authors.initials: C
authors.lastname: Lim
authors.affiliation: Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Henri Mondor Hospital, 51 Avenue De Lattre De Tassigny, 94010, Créteil, France.
authors.forename: Eylon
authors.initials: E
authors.lastname: Lahat
authors.affiliation: Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Henri Mondor Hospital, 51 Avenue De Lattre De Tassigny, 94010, Créteil, France.
authors.forename: Concepcion Gomez I
authors.initials: CG
authors.lastname: Gavara
authors.affiliation: Department of Anesthesia and Liver Intensive Care Unit, AP-HP Henri Mondor Hospital, Créteil, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Levesque
authors.affiliation: Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Henri Mondor Hospital, 51 Avenue De Lattre De Tassigny, 94010, Créteil, France.|INSERM 955, Créteil, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Compagnon
authors.affiliation: Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Henri Mondor Hospital, 51 Avenue De Lattre De Tassigny, 94010, Créteil, France. daniel.azoulay@hmn.aphp.fr.|INSERM 955, Créteil, France. daniel.azoulay@hmn.aphp.fr.
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D017048:Health Care Costs; D006498:Hepatectomy / Q000191:economics* / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000191:economics*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D019990:Perioperative Care / Q000191:economics; D057216:Propensity Score; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000191:economics*; D016896:Treatment Outcome