Robotic anatomical hepatectomy had fewer severe complications despite harder cases

The edition in brief

A post hoc analysis of the ROC'N'ROLL randomised trial examined 57 of 81 participants scheduled for minimally invasive anatomical hepatectomy. Severe complications (Clavien-Dindo grade III or above at 90 days) occurred in 13% after robotic and 37% after laparoscopic surgery (OR 0.27, 95% CI 0.07-0.97). The robotic arm had larger tumours (median 59 vs 40 mm) and higher IWATE difficulty scores, and longer operating times (252 vs 190 minutes). No subgroup sample size calculation was performed. By contrast, a meta-analysis of 16 East Asian studies of gastrectomy for gastric cancer in overweight, obese or high-visceral-adiposity patients found no clear difference between robotic and laparoscopic surgery: overall complications RR 0.81 (95% CI 0.60-1.10, I-squared 0%), major complications RR 0.56 (0.20-1.52), operative time +31 minutes (-9.6 to +71.9). Certainty was very low for every primary outcome. A two-centre series of 444 adrenalectomies compared hand-assisted laparoscopic, transperitoneal laparoscopic and retroperitoneoscopic routes. Hand-assisted surgery took the largest tumours (median 6.5 cm) with the shortest operative time but the highest complication rate (16.5% vs 7.6% vs 8.8%) and longest stay. A propensity-matched comparison of 141 pairs undergoing single-port totally extraperitoneal inguinal hernia repair found articulated instruments shortened median operative time from 40 to 35 minutes with no difference in complications. A US Multi-Society Task Force consensus statement states that serrated polyposis syndrome is the commonest polyposis syndrome, often goes unrecognised, carries raised colorectal cancer risk, and that first-degree relatives should undergo colonoscopic screening.