Robotic Versus Laparoscopic Hepatectomy: A Single Surgeon Experience of 629 Consecutive Minimally Invasive Liver Resections.

BACKGROUND: Robotic surgery has the potential to broaden the indications for minimally invasive liver surgery owing to its technical advantages. This paper compares our experience with robotic liver surgery (RLS) with conventional laparoscopic liver surgery (LLS). METHODS: All consecutive liver resections between October 2011 and October 2022 were selected from our prospective database to be included in this cohort study. Patients who underwent RLS were compared with a LLS group for operative and postoperative outcomes. RESULTS: In total, 629 patients were selected from our database, including 177 patients who underwent a RLS and 452 patients who had LLS. Colorectal liver metastasis was the main indication for surgery in both groups. With the introduction of RLS, the percentage of open resections decreased significantly (32.6% from 2011 to 2020 vs. 11.5% from 2020 onward, P < 0.001). In the robotic group, redo liver surgery was more frequent (24.3% vs. 16.8%, P = 0.031) and the Southampton difficulty score was higher (4 [IQR 4 to 7] vs. 4 [IQR 3 to 6], P = 0.02). Median blood loss was lower (30 vs. 100 ml, P < 0.001), and postoperative length of stay (LOS) was shorter in the robotic group (median 3 vs. 4 days, P < 0.001). There was no significant difference in postoperative complications. Cost related to the used instruments and LOS was significantly lower in the RLS group (median €1483 vs. €1796, P < 0.001 and €1218 vs. €1624, P < 0.001, respectively), while cost related to operative time was higher (median €2755 vs. €2470, P < 0.001). CONCLUSIONS: RLS may allow for a higher percentage of liver resections to be completed in a minimally invasive way with lower blood loss and a shorter LOS.

Healthcare utilization and related cost of midshaft clavicle fracture treatment in Belgium.

INTRODUCTION: The debate regarding the economic impact and cost effectiveness of surgical midshaft clavicle fracture treatment is ongoing. Variations exist between healthcare systems in terms of financing, provider payment mechanism and the role of the government in all of this. Therefore, the primary aim of our study was to describe the in-hospital-related healthcare costs associated with midshaft clavicle fracture treatment in Belgium. The secondary aim was to define those clinical variables that drive the costs related to surgically treated clavicle fractures and define strategies that could reduce these costs. PATIENTS AND METHODS: A total of 345 patients with a midshaft clavicle fracture were included in the study. We selected 17 clinical variables and 5 cost categories were defined. Three multivariate linear models were built to determine which parameters drive the costs. RESULTS: The median total healthcare cost for non-operatively treated patients was €367 and the median total cost for operatively treated patients was €3296. The length-of-stay was the most important variable that predicted the total cost. The clinical variables Number of fracture fragments, Delayed Stage Surgery, Revision Surgery and Infection most influenced the length-of-stay. DISCUSSION: In conclusion, the initial healthcare utilization cost of operatively treated midshaft clavicle fractures is larger than that of non-operatively treated fractures. The length-of-stay is the most important parameter that drives the cost and is predominantly influenced by patients' age, fracture complexity and complications requiring a surgical re-intervention. LEVEL OF EVIDENCE: III.

Segmentectomy or lobectomy for early-stage non-small-cell lung cancer: a systematic review and meta-analysis.

OBJECTIVES: The role of segmentectomy in early-stage non-small-cell lung cancer (NSCLC) remains a matter of debate. We performed a meta-analysis to evaluate the oncological outcomes following segmentectomy versus lobectomy for stage I, stage IA only and stage IA <2 cm only. METHODS: We systematically searched the literature for articles reporting on overall survival (OS), cancer-specific survival (CSS) or recurrence-free survival (RFS). The hazard ratios (HRs) were retrieved and pooled using an inverse variance-weighted approach. RESULTS: Twenty-eight studies were included in the analysis. In stage I, segmentectomy was found to be inferior to lobectomy for all 3 outcomes with HR: 1.25 (P = 0.01) for OS, 1.59 (P = 0.02) for CSS and 1.40 (P < 0.001) for RFS. In stage IA, the differences were significant for OS and CSS, though not for RFS with HR: 1.31 (P = 0.04), 1.56 (P = 0.02) and 1.22 (P = 0.11), respectively. In stage IA <2 cm, no significant differences were found between segmentectomy and lobectomy with HR: 1.13 (P = 0.37) for OS, 1.02 (P = 0.95) for CSS and 1.24 (P = 0.11) for RFS. CONCLUSIONS: For stages I and IA, lobectomy showed superior results whereas for tumours <2 cm, our study did not find significant differences in oncological outcomes between both groups. These results suggest that segmentectomy might be a valuable alternative to lobectomy for NSCLC in tumours <2 cm.