Better outcomes of robotic liver resection in segment VII/VIII compared to open and laparoscopic approach.

BACKGROUND: With the introduction of minimally invasive surgery, laparoscopic and robotic approaches have become increasingly popular for liver resections. However, few studies have compared the perioperative outcomes of open (OLR), laparoscopic (LLR), and robotic liver resections (RLR) together at once for lesions located in the superior parts of the right anterior and posterior segments, S7 and S8. This study reports data for S7 and S8 up to 5 years post-operation. METHODS: Perioperative data of S7 and S8 resections performed at Prince of Wales Hospital from January 2014 to December 2024 were retrieved. For statistically significant variables (p < 0.05), pairwise comparisons using Bonferroni correction was performed. Kaplan-Meier method was used for survival analysis. RESULTS: A total of 162 resections were retrospectively analysed, including 137 open, 14 laparoscopic, and 11 robotic liver resections. Robotic resections achieved the shortest post-operative length of stay (OLR: 7, LLR: 6, RLR: 4 days, p < 0.001) out of the 3 approaches and a 0.0% major complication rate (OLR: 11.7%, LLR: 0.0%, RLR: 0.0%, p = 0.385). Laparoscopic resections had the shortest operative duration (OLR: 175, LLR: 160.5, RLR: 190 min, p < 0.001) and least amount of intra-operative blood loss (OLR: 230, LLR, 60.5, RLR, 100 mL, p = 0.401). CONCLUSIONS: Despite an increased operating time, robotic liver resection demonstrated lower rates of major complications and shorter post-operative length of stay compared to open and laparoscopic resections. R1 resection rate and intra-operative blood loss were also comparable to laparoscopic liver resection. This solidifies robotic liver resection as a safe and effacious alternative to its open and laparoscopic counterparts.