Surg Endosc. 2026 Apr 20. doi: 10.1007/s00464-026-12678-9. Online ahead of print.
ABSTRACT
INTRODUCTION: Although minimally invasive (MIS) liver resections are associated with improved outcomes, uptake remains slow.
METHODS: Using data from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS), adults who underwent elective liver resections (2016-2020) were identified. Approach was classified as MIS (laparoscopic or robotic-assisted) or open. Annual utilization was characterized by approach and association between approach and patient and hospital variables was estimated.
RESULTS: Among 63,280 adult liver resections, 22.5% were MIS. MIS resections increased from 21.3% in 2016 to 22.5% in 2020. Laparoscopy alone decreased from 18.4 to 14.9%, while robotic-assistance increased from 2.9 to 7.6%. In multivariable analysis, patients were less likely to undergo MIS resection if they were in a county with < 250,000 people (vs. > 250,000, OR [95% CI], 0.82 [0.73-0.93]). Patients were more likely to undergo a MIS resection if they had a benign indication (vs. malignancy, OR [95% CI], 2.9 [2.49-3.38]), or were undergoing a partial hepatectomy (vs. lobectomy, OR, [95% CI], 2.62 [2.24-3.07]).
CONCLUSION: MIS liver resection increased between 2016 and 2020, driven by an increase in robotic-assisted surgery and despite a reduction in laparoscopic surgery. Rurality, indication, and resection type were contributors to a MIS vs. open approach.
PMID:42301463 | DOI:10.1007/s00464-026-12678-9