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The aim of this prospective study was to evaluate safety and feasibility of robotic liver surgery and compare outcomes with conventional laparoscopy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We here report the results of a single-center, prospective, post-marketing observational study (DRKS00017229) investigating the safety and feasibility of robotic liver surgery. Baseline characteristics, surgical complexity (using the IWATE score), and postoperative outcomes were then compared to laparoscopic liver resections performed at our center between January 2015 and December 2020. A propensity score-based matching (PSM) was applied to control for selection bias.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One hundred twenty nine robotic liver resections were performed using the da Vinci Xi surgical system (Intuitive) in this prospective study and were compared to 471 consecutive laparoscopic liver resections. After PSM, both groups comprised 129 cases with similar baseline characteristics and surgical complexity. There were no significant differences in intraoperative variables, such as need for red blood cell transfusion, duration of surgery, or conversion to open surgery. Postoperative complications were comparable after robotic and laparoscopic surgery (Clavien\u2013Dindo\u2009\u2265\u20093a: 23% vs. 19%,<jats:italic>p<\/jats:italic>\u2009=\u20090.625); however, there were more bile leakages grade B\u2013C in the robotic group (17% vs. 7%,<jats:italic>p<\/jats:italic>\u2009=\u20090.006). Length of stay and oncological short-term outcomes were comparable.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We propose robotic liver resection as a safe and feasible alternative to established laparoscopic techniques. The object of future studies must be to define interventions where robotic techniques are superior to conventional laparoscopy.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00464-021-08770-x","type":"journal-article","created":{"date-parts":[[2022,5,31]],"date-time":"2022-05-31T20:02:50Z","timestamp":1654027370000},"page":"5854-5862","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Robotic vs. laparoscopic liver surgery: a single-center analysis of 600 consecutive patients in 6\u00a0years"],"prefix":"10.1007","volume":"36","author":[{"given":"Moritz","family":"Schmelzle","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3372-609X","authenticated-orcid":false,"given":"Linda","family":"Feldbr\u00fcgge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santiago Andres","family":"Ortiz Galindo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Moosburner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anika","family":"K\u00e4stner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Krenzien","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Benzing","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Biebl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"\u00d6llinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Malinka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenzel","family":"Sch\u00f6ning","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johann","family":"Pratschke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,5,31]]},"reference":[{"key":"8770_CR1","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1016\/j.suronc.2018.10.005","volume":"27","author":"A Andreou","year":"2018","unstructured":"Andreou A, Struecker B, Raschzok N, Krenzien F, Haber P, Wabitsch S, Waldbaur C, Touet EM, Eichelberg AC, Atanasov G, Biebl M, Bahra M, \u00d6llinger R, Schmelzle M, Pratschke J (2018) Minimal-invasive versus open hepatectomy for hepatocellular carcinoma: comparison of postoperative outcomes and long-term survivals using propensity score matching analysis. 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Johann Pratschke reports a research grant from Intuitive Surgical Deutschland GmbH for the conduction of the present study. Outside of the submitted work, he reports personal fees or non-financial support from Johnson & Johnson, Medtronic, AFS Medical, Astellas, CHG Meridian, Chiesi, Falk Foundation, La Fource Group, Merck, Neovii, NOGGO, pharma consult Peterson, and promedicis. Linda Feldbr\u00fcgge, Santiago Andres Ortiz Galindo, Simon Moosburner, Anika K\u00e4stner, Felix Krenzien, Christian Benzing, Matthias Biebl, Robert \u00d6llinger, Thomas Malinka, and Wenzel Sch\u00f6ning have no conflict of interest or financial ties to disclose.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}}]}}