Robotic-assisted versus laparoscopic versus open liver resection: comparison of postoperative outcomes according to the IWATE difficulty score.

IF 2.7 2区医学 Q2 SURGERY

Surgical Endoscopy And Other Interventional Techniques Pub Date : 2025-09-17 DOI:10.1007/s00464-025-12231-0

Schaima Abdelhadi, Mohamad El-Ahmar, Sepehr Abbasi Dezfouli, Katharina Vedder, Maike Hermann, Vanessa Orth, Mahmoud Halawa, Meik Moennichs, Christoph Reissfelder, Flavius Sandra-Petrescu

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引用次数: 0

Abstract

Background: Minimally invasive liver surgery (MILS) has become increasingly established, yet the relative benefits of laparoscopic (LLR) and robotic-assisted liver resection (RLR) compared with open liver resection (OLR) across different levels of surgical difficulty remain debated. This study aimed to compare perioperative outcomes of RLR, LLR, and OLR stratified by the IWATE difficulty score.

Methods: All consecutive patients undergoing elective liver resection between April 2018 and December 2024 at a high-volume hepatobiliary center were retrospectively analyzed from a prospectively maintained database. Patients were stratified into low/intermediate (IWATE 0-6) and advanced/expert (IWATE 7-12) groups. Multivariable regression and interaction term analyses were performed to adjust for confounders and assess the modifying effect of surgical difficulty.

Results: A total of 686 patients were included: 425 (62%) underwent LLR, 101 (15%) RLR, and 160 (23%) OLR. Of these, 400 (58%) were advanced/expert resections. Minimally invasive approaches were associated with significantly reduced blood loss, morbidity, and length of stay compared with OLR across all IWATE levels. In advanced/expert resections, RLR provided the greatest benefit, with lower major complications (8% vs. 17% LLR vs. 23% OLR) and shorter length of stay (median 6 vs. 9 days OLR). Multivariable analyses confirmed these findings, with both LLR (OR 0.24, 95% CI 0.10-0.55) and RLR (OR 0.24, 95% CI 0.06-1.00) independently associated with reduced major complications compared to OLR. Interaction analyses demonstrated that the comparative advantage of RLR was most pronounced in advanced/expert resections, while LLR showed particular efficiency in low/intermediate cases.

Conclusion: Both LLR and RLR are safe and effective across all levels of surgical difficulty. RLR, however, offers distinct advantages in technically demanding advanced and expert cases. These findings reinforce the role of MILS as the preferred standard and highlight the importance of tailoring the surgical approach to case complexity.

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机器人辅助、腹腔镜和开放肝切除术：根据IWATE难度评分的术后结果比较。

背景：微创肝手术（MILS）已经越来越成熟，然而腹腔镜（LLR）和机器人辅助肝切除术（RLR）与开放肝切除术（OLR）在不同手术难度水平上的相对优势仍存在争议。本研究旨在比较按IWATE难度评分分层的RLR、LLR和OLR的围手术期结果。方法：回顾性分析2018年4月至2024年12月在大容量肝胆中心连续接受择期肝切除术的所有患者的前瞻性维护数据库。患者被分为低/中级（IWATE 0-6）和高级/专家（IWATE 7-12）组。采用多变量回归和相互作用项分析来调整混杂因素并评估手术难度的修改效果。结果：共纳入686例患者：425例（62%）接受了LLR， 101例（15%）接受了RLR， 160例（23%）接受了OLR。其中400例（58%）为高级/专家切除。在所有IWATE水平上，与OLR相比，微创入路可显著减少出血量、发病率和住院时间。在高级/专家切除中，RLR提供了最大的益处，主要并发症较低（8% vs 17% LLR vs 23% OLR），住院时间较短（中位6 vs 9天OLR）。多变量分析证实了这些发现，与OLR相比，LLR （OR 0.24, 95% CI 0.10-0.55）和RLR （OR 0.24, 95% CI 0.06-1.00）与主要并发症的减少独立相关。相互作用分析表明，RLR的比较优势在高级/专家切除中最为明显，而LLR在低/中级病例中表现出特别的效率。结论：在所有手术难度水平下，LLR和RLR均安全有效。然而，RLR在技术要求高的高级和专家案例中提供了明显的优势。这些发现强化了MILS作为首选标准的作用，并强调了根据病例复杂性定制手术入路的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Surgical Endoscopy And Other Interventional Techniques 医学-外科

CiteScore

6.10

自引率

12.90%

发文量

890

审稿时长

6 months

期刊介绍： Uniquely positioned at the interface between various medical and surgical disciplines, Surgical Endoscopy serves as a focal point for the international surgical community to exchange information on practice, theory, and research. Topics covered in the journal include: -Surgical aspects of: Interventional endoscopy, Ultrasound, Other techniques in the fields of gastroenterology, obstetrics, gynecology, and urology, -Gastroenterologic surgery -Thoracic surgery -Traumatic surgery -Orthopedic surgery -Pediatric surgery