Robotic Versus Laparoscopic Liver Resection in Various Settings: An International Multicenter Propensity Score Matched Study of 10.075 Patients.

OBJECTIVE: To compare the perioperative outcomes of robotic liver surgery (RLS) and laparoscopic liver surgery (LLS) in various settings. BACKGROUND: Clear advantages of RLS over LLS have rarely been demonstrated, and the associated costs of robotic surgery are generally higher than those of laparoscopic surgery. Therefore, the exact role of the robotic approach in minimally invasive liver surgery remains to be defined. METHODS: In this international retrospective cohort study, the outcomes of patients who underwent RLS and LLS for all indications between 2009 and 2021 in 34 hepatobiliary referral centers were compared. Subgroup analyses were performed to compare both approaches across several types of procedures: (1) minor resections in the anterolateral (2, 3, 4b, 5, and 6) or (2) posterosuperior segments (1, 4a, 7, 8), and (3) major resections (≥3 contiguous segments). Propensity score matching was used to mitigate the influence of selection bias. The primary outcome was textbook outcome in liver surgery (TOLS), previously defined as the absence of intraoperative incidents ≥grade 2, postoperative bile leak ≥grade B, severe morbidity, readmission, and 90-day or in-hospital mortality with the presence of an R0 resection margin in case of malignancy. The absence of a prolonged length of stay was added to define TOLS+. RESULTS: Among the 10.075 included patients, 1.507 underwent RLS and 8.568 LLS. After propensity score matching, both groups constituted 1.505 patients. RLS was associated with higher rates of TOLS (78.3% vs 71.8%, P < 0.001) and TOLS+ (55% vs 50.4%, P = 0.026), less Pringle usage (39.1% vs 47.1%, P < 0.001), blood loss (100 vs 200 milliliters, P < 0.001), transfusions (4.9% vs 7.9%, P = 0.003), conversions (2.7% vs 8.8%, P < 0.001), overall morbidity (19.3% vs 25.7%, P < 0.001), and microscopically irradical resection margins (10.1% vs. 13.8%, P = 0.015), and shorter operative times (190 vs 210 minutes, P = 0.015). In the subgroups, RLS tended to have higher TOLS rates, compared with LLS, for minor resections in the posterosuperior segments (n = 431 per group, 75.9% vs 71.2%, P = 0.184) and major resections (n = 321 per group, 72.9% vs 67.5%, P = 0.086), although these differences did not reach statistical significance. CONCLUSIONS: While both produce excellent outcomes, RLS might facilitate slightly higher TOLS rates than LLS.

Value of ultrasound and computed tomography in the diagnosis of acute appendicitis with histopathology as gold standard.

BACKGROUND: To evaluate the value of ultrasound (US), computed tomography (CT) and laboratory testing in diagnosing acute appendicitis and to evaluate the impact on the treatment of acute appendicitis, keeping histopathology as the gold standard. Retrospective evaluation of all patients treated surgically for appendicitis from 1 January 2016 to 31 December 2018 at Sint-Andries Hospital, Tielt, Belgium. METHODS: For each patient, we recorded: age, sex, duration of hospitalization, type of radiological investigation, fever (>37.3 °C), C-reactive protein (CRP), leukocyte particle count (LPC), Alvarado score and the type of surgery. For US and CT sensitivity, specificity and negative appendectomy rate were evaluated. RESULTS: Over a period of 3 years, 304 appendectomies were performed. The overall prevalence of appendicitis was 95.1%. Mean age was 31 years. All patients underwent radiological examination. US was performed in 35.9% (109), CT in 50.3% (153) and CT after US in 13.8% (42) of all cases. The sensitivity and specificity of CT were 99.4% and 80.0%, respectively. For US, the respective figures were 74.8 and 62.5%. CRP and LPC were significantly higher in the appendicitis group, compared to the non-appendicitis group. The negative appendectomy rate was slightly higher in the CT after US group i.e. 7.1% (3/42) compared to 4.67% (5/107) in the US group and 4.50% (7/155) in the CT group. CONCLUSIONS: The diagnostic value of US and CT are both very high. The diagnostic value of clinical features and biochemistry alone is quite low. By combining radiological examination, clinical examination and laboratory values, low negative appendectomy rates can be achieved.