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. 2019 Aug;33(8):2539-2547.
doi: 10.1007/s00464-018-6547-8. Epub 2018 Oct 22.

Robotic-assisted laparoscopic surgery for complex hepatolithiasis: a propensity score matching analysis

Jie Shu  1 , Xiao-Jun Wang  1 , Jian-Wei Li  1 , Ping Bie  1 , Jian Chen  1 , Shu-Guo Zheng  2
Affiliations

Robotic-assisted laparoscopic surgery for complex hepatolithiasis: a propensity score matching analysis

Jie Shu et al. Surg Endosc. 2019 Aug.

Abstract

Background: The indication for laparoscopic treatment of hepatolithiasis is early-stage regional hepatolithiasis. Open surgery (OS) is the traditional treatment for complex hepatolithiasis. Robotic-assisted laparoscopic surgery (RLS) overcomes the limitations of the traditional laparoscopic approach in terms of the visual field, instruments, and operational flexibility. RLS is thus theoretically indicated for the treatment of complicated hepatolithiasis. This study aimed to evaluate the safety, efficacy, and feasibility of RLS for the treatment of complicated hepatolithiasis.

Methods: From October 2010 to August 2017, 26 consecutive patients who underwent RLS and 287 consecutive patients who underwent OS for the treatment of complicated hepatolithiasis at our center were included in this study. We performed a propensity score matching (PSM) analysis between patients who underwent RLS and patients who underwent OS at a ratio of 1:2. Twenty-six patients were included in the RLS group, and 52 patients were included in the OS group.

Results: The groups exhibited no differences with respect to age, sex, location of stones, liver function, history of previous surgery, or Child-Pugh classification. There were no differences in the postoperative complication rates (46.2% vs. 63.5%, p = 0.145), intraoperative stone clearance rates (96.2% vs. 90.4%, p = 1.000), or final stone clearance rates (100% vs. 98.1%, p = 0.652) between the two groups. The RLS group had less blood loss (315.38 ± 237.81 vs. 542.88 ± 518.70 ml, p = 0.037), a lower transfusion rate (15.4% vs. 46.2%, p = 0.008), shorter oral intake times (3.50 ± 1.30 vs. 5.88 ± 4.00 days, p = 0.004), and shorter postoperative hospital stays (13.54 ± 6.54 vs. 17.81 ± 7.49 days, p = 0.016) than the OS group. At a median follow-up of 48 months (range 7-90 months), there were no differences in stone recurrence rate (3.8% vs. 13.5%, p = 0.356) or recurrent cholangitis rate (3.8% vs. 3.8%, p = 1.000) between RLS and OS patients.

Conclusion: RLS for complicated hepatolithiasis is safe and feasible with advantages over OS in terms of intraoperative blood loss, transfusion rate, duration of hospital stays, and postoperative recovery.

Keywords: Hepatolithiasis; Laparoscopy; Liver resection; Minimally invasive surgery; PSM; Robotic.

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References

    1. Br J Surg. 2006 Jan;93(1):67-72 - PubMed
    1. World J Surg. 2007 Mar;31(3):479-82 - PubMed
    1. Surg Endosc. 2007 Apr;21(4):619-24 - PubMed
    1. Surg Clin North Am. 2003 Dec;83(6):1405-19 - PubMed
    1. Dig Liver Dis. 2013 Jun;45(6):493-8 - PubMed

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