# Comparison of laparoscopic and robotic liver surgery: a German real-world analysis

## TL;DR

This study compares robotic and laparoscopic liver surgeries in real-world settings, finding robotic surgery is used more often for complex cases.

## Contribution

The study provides real-world data on robotic liver surgery usage and patient selection in Germany.

## Key findings

- Robotic resections were more common for complex cases like liver cirrhosis and malignant tumors.
- Laparoscopic surgeries had shorter operation times compared to robotic procedures.
- No significant differences were found in complication rates between the two methods.

## Abstract

Robotic operations are becoming increasingly important in minimally invasive liver surgery. Although safety and efficiency have already been demonstrated, real-world data regarding robotic experiences compared to laparoscopic procedures remain limited.

We conducted a retrospective analysis of all patients who underwent laparoscopic or robotic resection for malignant or benign liver tumors between January 2020 and June 2024 at the University Medical Center Hamburg-Eppendorf.

A total of 308 patients met the inclusion criteria. Of these, 133 patients underwent robotic resection with the DaVinci®-Xi system, while 175 patients were operated laparoscopically. In the robotic cohort, major resections were performed more frequently (27 [20.3%] vs. 14 [8.0%]; p = 0.002). Moreover, the rate of patients with liver cirrhosis was higher (34.6% vs. 20%; p = 0.004), and more patients were classified as ASA 3–4 (61.7% vs. 48.6%; p = 0.022). Additionally, a greater number of patients with hepatocellular carcinoma and biliary neoplasia underwent robotic resection (54.0% vs. 34.2%; p = 0.004). Operation time was significantly shorter in the laparoscopic group (132 min vs. 187 min; p = 0.004). There were no statistically significant differences between groups for conversion rate, intraoperative blood loss, overall complication rate, and complications classified as \documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{mathrsfs}
\usepackage{upgreek}
\setlength{\oddsidemargin}{-69pt}
\begin{document}$$\ge$$\end{document}≥ 3A according to the Clavien–Dindo system.

In a real-world setting, we retrospectively observed a selection tendency favoring the robotic approach for multimorbid patients, particularly those with liver cirrhosis and primary malignant liver tumors with higher complexity, highlighting the evolving role of robotic surgery in managing complex liver resections.