The safety and efficacy of approaches to liver resection: A meta-analysis

Nicole R. Jackson, Adam Hauch, Tian Hu, Joseph F. Buell, Douglas P. Slakey, Emad Kandil

Research output: Contribution to journalArticlepeer-review

45 Scopus citations


Background: The aim of this study is to compare the safety and efficacy of conventional laparotomy with those of robotic and laparoscopic approaches to hepatectomy. Database: Independent reviewers conducted a systematic review of publications in PubMed and Embase, with searches limited to comparative articles of laparoscopic hepatectomy with either conventional or robotic liver approaches. Outcomes included total operative time, estimated blood loss, length of hospitalization, resection margins, postoperative complications, perioperative mortality rates, and cost measures. Outcome comparisons were calculated using random-effects models to pool estimates of mean net differences or of the relative risk between group outcomes. Forty-nine articles, representing 3702 patients, comprise this analysis: 1901 (51.35%) underwent a laparoscopic approach, 1741 (47.03%) underwent an open approach, and 60 (1.62%) underwent a robotic approach. There was no difference in total operative times, surgical margins, or perioperative mortality rates among groups. Across all outcome measures, laparoscopic and robotic approaches showed no difference. As compared with the minimally invasive groups, patients undergoing laparotomy had a greater estimated blood loss (pooled mean net change, 152.0 mL; 95% confidence interval, 103.3–200.8 mL), a longer length of hospital stay (pooled mean difference, 2.22 days; 95% confidence interval, 1.78–2.66 days), and a higher total complication rate (odds ratio, 0.5; 95% confidence interval, 0.42–0.57). Conclusion: Minimally invasive approaches to liver resection are as safe as conventional laparotomy, affording less estimated blood loss, shorter lengths of hospitalization, lower perioperative complication rates, and equitable oncologic integrity and postoperative mortality rates. There was no proven advantage of robotic approaches compared with laparoscopic approaches.

Original languageEnglish (US)
Article numbere2014.00186
JournalJournal of the Society of Laparoendoscopic Surgeons
Issue number1
StatePublished - 2015

Bibliographical note

Publisher Copyright:
© 2015 by JSLS, Journal of the Society of Laparoendoscopic Surgeons.


  • Hepatectomy
  • Laparoscopy
  • Metaanalysis
  • Minimally invasive surgery
  • Robotics


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