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Lai et al. Robotic hepatectomy for HCC

analysis of minor hepatectomies, when compared with rate and hospital stay. However, robotic surgery is more
the conventional laparoscopic approach, the robotic expensive than conventional laparoscopic approach. It
group had similar blood loss (mean, 373.4 vs. 347.7 should be emphasized that considering robot-assisted
mL), morbidity rate (3% vs. 9%), mortality rate (0% laparoscopic partial hepatectomy requires 4 conditions:
vs. 0%), and R0 resection rate (90.9% vs. 90.9%). (1) appropriate selection of patients; (2) follow the
However, the robotic group had a significantly longer principle of open liver surgery; (3) specific expertise
operative time (202.7 vs. 133.4 min). Recently, Lai and training, in both liver and laparoscopic surgery;
and Tang [34] also compared the long-term oncological and (4) familiarization with the robotic machine and pay
outcomes of robotic (n = 100) and conventional precaution of its potential dangers, such as visceral
laparoscopic partial hepatectomy (n = 35) for HCC. injury by robotic arm, total loss of tactile feedback.
Robotic group had a significant higher proportion For the oncological outcome for robotic resection
of major hepatectomies (27% vs. 2.9%) and tumors of HCC, the data are very limited. Oncological data
located at or across posterosuperior segments (29% from homogenous series of HCC after robotic partial
vs. 0%) than conventional laparoscopic group. For the hepatectomy was needed. Its future implementation
perioperative outcomes, robotic group had a significant and clinical value will depend on the advantages that
longer mean operating time (207.4 vs. 134.2 min). it can provide over conventional laparoscopy or open
Both groups had similar blood loss (334.6 vs. 336 mL). surgery.
There was no difference in morbidity (14% vs. 20%)
and mortality rate (0% vs. 0%). Concerning oncological DECLARATIONS
outcomes, there was no difference between 2 groups
in R0 resection rate (96% vs. 91.4%), 5-year overall Authors’ contributions
survival (65% vs. 48%), and disease-free survival (42% Proposed the idea, structure, and content: E.C.H. Lai
vs. 38%). Recently, Magistri et al. [35] also reported the Literature search: E.C.H. Lai, D.T.M. Chung, O.C.Y.
short-term outcomes of patients who had underwent Chan
robotic resections (n = 22) and laparoscopic (n = 24) First draft: E.C.H. Lai
resections for HCC. In the robotic group, there were 6 Revision and final proof read: D.T.M. Chung, O.C.Y.
left lateral sectionectomies, 2 right hepatectomies, and Chan, C.N. Tang
14 minor resections, including 9 segmentectomies and
5 wedge resections. In the laparoscopic group, there Financial support and sponsorship
were 14 segmentectomies and 10 wedge resections, None.
but no major hepatectomies. Operating time was
significantly longer in the robotic group (318 vs. 211 min), Conflicts of interest
whereas estimated blood loss was comparable There are no conflicts of interest.
between the two groups (400 vs. 320 mL), with one
case needed blood transfusion in each group. In Patient consent
the robotic group, Clavien-Dindo classes I and II Not applicable.
complication was significantly less frequent than in
the laparoscopic group (n = 13 vs. n = 22). During Ethics approval
analyzing specific complications, pleural effusion was Not applicable.
significantly less frequent in the robotic group (n = 2
vs. n = 10). Regarding major complications, there were REFERENCES
no differences of incidence among the two cohorts
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282 Hepatoma Research ¦ Volume 3 ¦ November 27, 2017