Clinical Outcomes of Robotic Posterosuperior Hepatectomy Compared to Major Hepatectomy: A Propensity Score-Matched Analysis of Liver Resection for Difficult Segments Using Robotic Platform.

Introduction: Minimally invasive resection of posterosuperior hepatic segments (i.e., segments VII and VIII) is a technically challenging operation due to limited visibility and accessibility. Therefore, this type of liver resection is mainly undertaken via a traditional open approach. We aimed to analyze the safety, feasibility, and efficacy of robotic posterosuperior resection and compare them with those of robotic major hepatectomy. Methods 128 patients undergoing robotic posterosuperior and major hepatectomy were included. Patient demographics, intra-, and postoperative outcomes were analyzed. Data are presented as median (mean ± SD). Results Robotic posterosuperior resection was undertaken in 32 patients, and these patients were propensity score-matched to 96 patients who underwent a robotic major hepatectomy. There were no significant differences in age, sex, BMI, past liver and abdominal operations, ASA, MELD score, Child-Pugh score, and number of patients with cirrhosis. In patients who underwent robotic posterosuperior resection versus major hepatectomy, there were no differences in the following intraoperative variables: operative duration (292 vs 281 minutes; p = 0.87), estimated blood loss (200 vs 175 mL; p = 0.32), and R1 status (0% vs 2%; p = 1.00). There were no open conversions. Postoperatively, there were no significant differences in outcomes, including Clavien-Dindo grade ≥ III complications (0% vs 4%; p = 0.57), length of stay (4 vs 4 days; p = 1.00), 30-day readmissions (22% vs 18%; p = 0.61), 30-and 90-day mortality (0% vs 1%; p = 1.00). The IWATE difficulty scores were significantly higher for the posterosuperior hepatectomies. Conclusions Robotic posterosuperior hepatectomy is safe, feasible, and effective with excellent clinical outcomes, similar to those of major hepatectomy.