3 Minimally Invasive vs Open Minor Liver Resection: A Single-Institution Propensity Score-Matched Analysis

Abstract Background Minimally invasive techniques for minor liver resections have advanced significantly, with robotic and laparoscopic approaches increasingly replacing traditional open surgery. While these methods are thought to improve patient outcomes and reduce healthcare costs, direct comparative data remain limited. Method A prospective dataset of 141 patients undergoing robotic (n = 47), laparoscopic (n = 47), and open (n = 47) minor liver resections at Southampton General Hospital (2022–2024) was analysed. Outcome measures included total hospital stay, HDU stay, intraoperative blood loss, transfusion requirement, readmission, grade ≥3 complications, and conversions to open surgery. Statistical analysis was performed using SPSS (Kruskal-Wallis and Chi-square tests). Cost effectiveness was evaluated based on per-procedure savings. Results Median total length of stay was significantly lower in the robotic and laparoscopic groups (3 days) compared to open surgery (5 days, p = .001). Robotic and laparoscopic procedures were associated with significantly lower intraoperative blood loss (100 mL) compared to open (525 mL, p < .001). Conversion to open surgery was significantly more common in the laparoscopic group (10 cases) than in the robotic group (2 cases, p = .013). Differences in transfusion rates (p = .091), readmission (p = .919), and major complications (p = .179) were not statistically significant. Estimated cost savings per procedure favoured robotic over open (£1374) and laparoscopic approaches (£488). Conclusions Robotic minor liver surgery demonstrated improved clinical outcomes and greater cost effectiveness compared to open and laparoscopic approaches. These findings support the continued integration of robotic surgery in hepatobiliary practice.