The impact of body mass index on perioperative outcomes after robotic liver resection

  • Iswanto SucandyEmail author
  • Abdelrahman Attili
  • Janelle Spence
  • Timothy Bordeau
  • Sharona Ross
  • Alexander Rosemurgy
Original Article


High body mass index (BMI) is associated with other multiple comorbidities such as non-alcoholic fatty liver disease, steatohepatitis, liver cirrhosis, and cardiopulmonary diseases, which can impact the perioperative outcomes following liver resection. We aimed to study the impact of BMI on perioperative outcomes after robotic liver resection. All the patients undergoing robotic liver resection between 2013 and 2017 were prospectively followed. The patients were divided into three groups (BMI < 25, BMI 25–35, BMI > 35 kg/m2) for illustrative purposes. Demographic and perioperative outcome data were compared. Data are presented as median (mean ± SD). Thirty-eight patients underwent robotic hepatectomy, 73% were women, age was 58 (57 ± 17.6) years, and ASA class was 3 (3 ± 0.5). Indications for surgery were neoplastic lesions in 34 patients (89%), hemangioma in two patients (6%), fibrous mass in one patient (2.5%), and focal nodular hyperplasia in one patient (2.5%). 32% of the patients underwent right or left hemihepatectomy, 21% underwent sectionectomy, 5% underwent central hepatectomy and the reminder underwent non-anatomical liver resection. Operative time was 261 (254.6 ± 94.3) min. Estimated blood loss was 175 (276 ± 294.8) ml. Length of hospital stay was 3 (5 ± 4.9) days. By regression analysis of the three BMI groups, estimated blood loss, rate of postoperative complication, rate of conversion, need for transfusion, length of ICU stay, and length of hospital stay did not have a significant relationship with BMI. A total of five patients (13%) experience complications. Four patients had complications that were nonspecific to liver resection, including acute renal injury, respiratory failure, and enterocutaneous fistula. One patient had bile leak, treated with ERCP stenting. No mortality was seen in this study. Obesity should not dissuade surgeons from utilizing minimally invasive robotic approach for liver resection. Robotic technique is a safe and feasible in patients with high BMI. The impact of BMI on outcomes is insignificant.


Robotic surgery Hepatobiliary Obesity Outcome Liver resection 



This paper was not funded in part or in whole by any organization.

Compliance with ethical standards

Conflict of interest

Iswanto Sucandy, MD, Abdelrahman Attili, MD, Janelle Spence, BA, Timothy Bordeau, BA, Sharona Ross, MD, Alexander Rosemurgy, MD declare that they have no conflict of interest to report with this study.

Ethical standards

All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Written informed consent was obtained from the patient for publication of this study. A copy of the written consent is available for review upon request.


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Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2019

Authors and Affiliations

  • Iswanto Sucandy
    • 1
    Email author
  • Abdelrahman Attili
    • 1
  • Janelle Spence
    • 1
  • Timothy Bordeau
    • 1
  • Sharona Ross
    • 1
  • Alexander Rosemurgy
    • 1
  1. 1.Southeastern Center for Digestive Disorder and Hepatopancreatobiliary Cancer, Advanced Minimally Invasive and Robotic SurgeryFlorida Hospital TampaTampaUSA

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