Robotic versus laparoscopic repeat hepatectomy: A comparative single-center study of perioperative outcomes

Purpose: A repeat liver resection is considered a technically challenging procedure and therefor an open approach is frequently preferred. With the introduction of minimally invasive liver surgery, laparoscopic repeat liver resection demonstrates favorable results, however, limited data on robotic repeat liver resections exists. Our aim is to compare the robotic approach with the laparoscopic one for a repeat liver resection. Methods: In a single-center retrospective analysis, we report the data of all minimally invasive repeat liver resections performed between September 2011 and August 2023. Short-term outcomes - including procedure time, blood loss, conversion rate, morbidity and mortality - were compared for a laparoscopic and a robotic approach. Results: A total of 136 minimally invasive repeat liver resections were performed, of which 56 robotic procedures and 80 laparoscopic procedures. Both groups were similar in baseline demographics, diagnosis and surgical procedure. While the mean procedure time was slightly longer in the robotics group by 15 min (145min and 130min, p = 0.04), the median blood loss was significantly lower in the robotic group (30 ml and 80 ml, p < 0.001). Additionally, there was a trend towards less conversions in the robotic group (n = 0 and n = 6, p = 0.42). Post-operative morbidity and mortality were similar in both groups. Conclusion: The robotic approach for minimally invasive repeat liver surgery is both safe and feasible, while also demonstrating favorable short-term outcomes. In our experience, the 'tunnel technique' - which avoids dissection of intra-abdominal adhesions - is a key advantage of this approach.