Robotic versus laparoscopic anatomical hepatectomy: a post hoc analysis of the ROC'N'ROLL randomized controlled trial
In brief
Robotic liver surgery had fewer severe complications than laparoscopy, 13% vs 37%
In an exploratory analysis of 57 patients, severe complications within 90 days occurred in 13% after robotic surgery and 37% after laparoscopic surgery. Robotic operations took longer, and patients had more complex cases; other outcomes showed no clear differences. The small post hoc comparison needs prospective validation before it can establish which patients benefit most.
- Journal
- Surgical endoscopy (Q1)
- Published
- 29 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Emrullah Birgin, Marie Heibel, Svetlana Hetjens, Erik Rasbach, Christoph Reissfelder, Patrick Téoule, et al.
- PMID
- 42811178
- DOI
- 10.1007/s00464-026-13425-w
Why clinicians should know about it
- Picked for Surgery (paper of the day, 2 October 2026): Robotic hepatectomy fewer severe complications despite higher complexity
Abstract
BACKGROUND: Robotic liver surgery may overcome technical limitations of laparoscopic approaches, particularly for anatomical hepatectomy. Comparative prospective data remain limited. METHODS: This exploratory post hoc analysis of the ROC'N'ROLL randomized controlled trial included patients scheduled for minimally invasive anatomical hepatectomy before randomization. Participants were randomized to robotic (RAH) or laparoscopic anatomical hepatectomy (LAH). The primary endpoint of this analysis was the rate of severe postoperative complications (Clavien-Dindo grade ≥ III) within 90 days. No subgroup-specific sample size calculation was performed. Secondary outcomes included conversion, operative time, blood loss, oncological outcomes, recovery, and patient-reported outcomes (PROs). RESULTS: Among 81 randomized participants, 57 were scheduled for anatomical hepatectomy (RAH, n = 30; LAH, n = 27). Baseline imbalances were present, with larger tumors in the RAH group (median, 59 vs 40 mm; P = 0.048) and higher IWATE difficulty scores (median, 10 vs 7; P = 0.029). Operating time was longer with RAH (median, 252 vs 190 min; P = 0.021). Severe complications occurred in 13% after RAH and 37% after LAH (odds ratio, 0.27; 95% CI, 0.07-0.97; P = 0.045). No clear between-group differences were observed in conversion, blood loss, length of stay, functional recovery, margin status, mortality, or PROs. CONCLUSIONS: Robotic anatomical hepatectomy was associated with fewer severe complications despite higher procedural complexity. These exploratory findings support its use in high-difficulty cases but require prospective validation. (DRKS00027531).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.