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Robotic Versus Open Major Hepatectomy- Lower Complications with Comparable Safety
Divya Randhawa MD¹, Sarah I Stier BA¹, Vanessa Cowan MD ¹, Amy Evenson MD ¹, Angela Chen MD ¹, Vincenzo Villani MD ¹, David Lee MD ¹, Devin Eckhoff MD¹, Martin Dib MD¹ 1 Division of Transplant Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States.
Background: Major hepatectomy is a technically demanding procedure associated with substantial morbidity. Robotic approach is increasingly adopted, but comparative data remain limited. We evaluated perioperative outcomes after robotic versus open major hepatectomy. Methods: We retrospectively analyzed 90 consecutive patients undergoing major hepatectomy (45 robotic; 45 open). Primary outcomes were 30-day overall and major complications (Clavien–Dindo ≥IIIa). Secondary outcomes included bile leak, transfusion, reoperation, readmission, mortality, and length of stay (LOS). Multivariable logistic regression adjusted for ASA physical status class and procedure type. LOS among survivors was analyzed using negative binomial regression. Results: Robotic hepatectomy was associated with lower rates of PRBC transfusion (4.4% vs 22.2%; p=0.03), 30-day overall complications (46.7% vs 73.3%; p=0.02), and bile leak (4.4% vs 31.1%; p=0.002). Major complications were less frequent robotically (15.6% vs 35.6%; p=0.052). Reoperation, readmission, and mortality were similar. After adjustment, robotic hepatectomy remained associated with lower odds of overall complications (OR 0.31, 95% CI 0.11–0.80; p=0.02) and bile leak (OR 0.05, 95% CI 0.002–0.28; p=0.002). Adjusted LOS was 33.2% shorter (IRR 0.67, 95% CI 0.46–0.98; p=0.04). Conclusion: Robotic major hepatectomy was associated with lower perioperative morbidity and shorter LOS, supporting its safety and potential perioperative benefits.
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