51
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Sucandy I, Durrani H, Ross S, Rosemurgy A. Technical approach of robotic total right hepatic lobectomy: How we do it? J Robot Surg 2018; 13:193-199. [PMID: 30276634 DOI: 10.1007/s11701-018-0881-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 09/24/2018] [Indexed: 12/13/2022]
Abstract
Despite advantages of minimally invasive surgery, many hepatobiliary surgeons are hesitant to offer this approach for major hepatic resection due to concerns of difficulty in liver manipulation, bleeding control, and suboptimal oncologic outcomes. The robotic surgical system has revolutionized the way traditional laparoscopic liver resection is undertaken. Limitations of traditional laparoscopy are being resolved by robotic technology. We aimed to describe aspects of minimally invasive liver surgery and our standardized technical approach. We discussed technical aspects of performing robotic total right hepatic lobectomy and described our standardized institutional method. A 79-year-old man with an 11-cm biopsy-proven hepatocellular carcinoma was taken to the operating room for a robotic total right hepatic lobectomy. Past medical and surgical history was consistent with hypertension and diabetes mellitus. Robotic extrahepatic Glissonean pedicle approach was used to gain inflow vascular control. Right hepatic artery and portal vein were individually dissected and isolated prior to division. An intraoperative robotic ultrasound was utilized to guide liver parenchymal transection, securing negative margins. Robotic vessel sealing device was used as the main energy device during the parenchymal transection. Right hepatic vein was transected intrahepatically using a linear stapler. Operative time was 200 min without intraoperative complications. Estimated blood loss was 100 ml. Postsurgical recovery was uneventful and he was discharged home on postoperative day 4. Minimally invasive robotic total right hepatic lobectomy is feasible with excellent perioperative outcomes.
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Affiliation(s)
- Iswanto Sucandy
- Florida Hospital Tampa, Advanced Minimally Invasive and Robotic Surgery, 3000 Medical Park Dr, Suite #500, Tampa, FL, 33613, USA.
| | - Hamza Durrani
- Florida Hospital Tampa, Advanced Minimally Invasive and Robotic Surgery, 3000 Medical Park Dr, Suite #500, Tampa, FL, 33613, USA
| | - Sharona Ross
- Florida Hospital Tampa, Advanced Minimally Invasive and Robotic Surgery, 3000 Medical Park Dr, Suite #500, Tampa, FL, 33613, USA
| | - Alexander Rosemurgy
- Florida Hospital Tampa, Advanced Minimally Invasive and Robotic Surgery, 3000 Medical Park Dr, Suite #500, Tampa, FL, 33613, USA
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52
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Guan R, Chen Y, Yang K, Ma D, Gong X, Shen B, Peng C. Clinical efficacy of robot-assisted versus laparoscopic liver resection: a meta analysis. Asian J Surg 2018; 42:19-31. [PMID: 30170946 DOI: 10.1016/j.asjsur.2018.05.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 02/21/2018] [Accepted: 05/30/2018] [Indexed: 02/07/2023] Open
Abstract
To compare the clinical efficacy and safety of robotic-assisted liver resection (RLR) and laparoscopic liver resection (LLR) by the means of meta-analytical techniques. We searched PubMed, Cochrane library, Embase and Web of Science databases, collecting randomized or non-randomized studies about robotic-assisted and laparoscopic liver resections. The searching cutoff date was 2017/6/30, all the data obtained were statistically analyzed using RevMan5.3 software recommended by Cochrane Collaboration. A total of thirteen articles, involving 938 patients were enrolled in meta-analysis. Among them, 435 cases underwent RLR, and 503 cases underwent LLR. Compared with LLR, the RLR had longer operative time [MD=65.49, 95%CI (42.00, 88.98) P<0.00001=more intraoperative blood loss [MD=69.88, 95%CI (27.11, 112.65) P=0.001] and a higher cost [MD=4.24, 95%CI (3.08, 5.39) P<0.00001=. There were no significant differences between the two groups in transfusion rate, complication rate, conversion rate, the R1 resection rate and hospital stay. In the subgroup analysis of surgery after 2010, a lower conversion rate was observed in RLR, other clinical outcomes are comparable between RLR and LLR. In the subgroup analysis of minor hepatectomy, RLR is still associated with longer operative time, but there is no difference in other outcomes. In the subgroup analysis of left hemihepatectomy or left lateral hepatectomy, RLR is associated with more blood loss. Although RLR associated with Longer operative time and more intraoperative blood loss, it displays the same safety and effectiveness as LLR for hepatectomies. And the high cost is still a major hindrance for the widely application of robotic surgery.
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Affiliation(s)
- Ruoyu Guan
- Department of Hepatobiliary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yongjun Chen
- Department of Hepatobiliary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Kui Yang
- Department of Hepatobiliary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Di Ma
- Department of Hepatobiliary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaoyong Gong
- Department of Hepatobiliary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Baiyong Shen
- Department of Hepatobiliary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chenghong Peng
- Department of Hepatobiliary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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53
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Intraoperative ultrasonography of robot-assisted laparoscopic hepatectomy: initial experiences from 110 consecutive cases. Surg Endosc 2018; 32:4071-4077. [PMID: 30151749 DOI: 10.1007/s00464-017-5854-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 08/22/2017] [Indexed: 01/29/2023]
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54
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Guerra F, Di Marino M, Coratti A. Robotic Surgery of the Liver and Biliary Tract. J Laparoendosc Adv Surg Tech A 2018; 29:141-146. [PMID: 30118390 DOI: 10.1089/lap.2017.0628] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The laparoscopic methods for major abdominal surgery are gaining increasing acceptance worldwide. Despite its relatively recent introduction in clinical practice, robotics has been accepted as an effective option to perform high-demanding procedures such as those required in hepatobiliary surgery. Some potential advantages over conventional laparoscopy have been suggested, but its actual role in clinical practice is still to be defined. METHODS The objective of this work is to critically review the available evidence on the application of robotic surgery to the liver and biliary tract. PubMed, Embase, and the Cochrane Library electronic databases were systematically searched for studies reporting on robotic hepatobiliary surgery with or without comparison with open surgery or conventional laparoscopy. RESULTS This review provides a comprehensive snapshot of the current application of the robot to the surgery of the liver and biliary tract. The overall available data show the noninferiority of the robotic system to conventional open and laparoscopic surgery. A number of studies suggest some potential advantages in performing high-demanding procedures in a minimally invasive fashion. CONCLUSIONS The robot can be used to perform various types of liver surgeries quite safely and competently, although the lack of randomized control trials, comparing it with open and laparoscopic surgery, precludes the possibility to reach definitive conclusions.
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Affiliation(s)
- Francesco Guerra
- Division of Oncological and Robotic General Surgery, Careggi University Hospital , Florence, Italy
| | - Michele Di Marino
- Division of Oncological and Robotic General Surgery, Careggi University Hospital , Florence, Italy
| | - Andrea Coratti
- Division of Oncological and Robotic General Surgery, Careggi University Hospital , Florence, Italy
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55
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Yu DC, Wu XY, Sun XT, Ding YT. Glissonian approach combined with major hepatic vein first for laparoscopic anatomic hepatectomy. Hepatobiliary Pancreat Dis Int 2018; 17:316-322. [PMID: 30108017 DOI: 10.1016/j.hbpd.2018.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 06/08/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic anatomic hepatectomy remains challenging because of the complex interior structures of the liver. Our novel strategy includes the Glissonian approach and the major hepatic vein first, which serves to define the external and internal landmarks for laparoscopic anatomic hepatectomy. METHODS Eleven cases underwent laparoscopic anatomic hepatectomy, including three right hepatectomies, three left hepatectomies, three right posterior hepatectomies, and two mesohepatectomies. The Glissonian approach was used to transect the hepatic pedicles as external demarcation. The major hepatic vein near the hepatic portal was exposed and served as the internal landmark for parenchymal transection. The liver parenchyma below and above the major hepatic vein was transected along the major hepatic vein. Fifty-nine subjects were used to compare the distance between the major hepatic vein and secondary Glisson pedicles among different liver diseases. RESULTS The average operative time was 327 min with an estimated blood loss of 554.55 mL. Only two patients received three units of packed red blood cells. The others recovered normally and were discharged on postoperative day 7. The distance between right posterior Glissonian pedicle and right hepatic vein was shorter in the patients with cirrhosis than that without cirrhosis, and this distance was even shorter in patients with hepatocellular carcinoma. CONCLUSION The Glissonian approach with the major hepatic vein first is easy and feasible for laparoscopic anatomic hepatectomy, especially in patients with hepatocellular carcinoma and cirrhosis.
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Affiliation(s)
- De-Cai Yu
- Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing 210008, China
| | - Xing-Yu Wu
- Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing 210008, China
| | - Xi-Tai Sun
- Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing 210008, China
| | - Yi-Tao Ding
- Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing 210008, China.
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56
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Robotic-assisted right posterior segmentectomies for liver lesions: single-center experience of an evolutional method in left semi-lateral position. J Robot Surg 2018; 13:231-237. [PMID: 29995223 DOI: 10.1007/s11701-018-0842-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 07/04/2018] [Indexed: 12/12/2022]
Abstract
Despite the popularity of minimally invasive surgery (MIS) for hepatectomy, limitations in the approach of the right posterior section of the liver remain. Although skills and approach techniques have been developed for hepatectomy of lesions in the posterior segments of the liver, most are performed laparoscopically and are limited to few experienced hands using rigid laparoscopic instruments. In this study, we tried a different approach area via the aid of a flexible robotic system. Since 2012, we have successfully completed more than 200 robotic hepatectomy procedures in our institution. Two different patient settings have been applied for right posterior segment lesions, including supine position as general setting in early cases and left semi-lateral decubitus setting in our later cases. The demographic data and perioperative outcomes between the two groups were analyzed in regard to different positioning. A total of 25 patients with right posterior segment lesions underwent robotic-assisted resection, 13 were placed in supine position and 12 in left semi-lateral position. The left semi-lateral group had significantly shorter operation time (306.0 versus 416.8 min, p = 0.023), less blood loss (203.9 versus 1092.3 mL, p = 0.030), and lower transfusion rates (0 versus 46.2%, p = 0.015). We described an evolutionary technique for robotic right posterior segmentectomies with the patient placed in left semi-lateral position. This method can be applied for most patients easily and is demonstrated as a safe and feasible approach in selected patients owing to its ability to overcome the difficulty of MIS hepatectomy for right posterior lesions.
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57
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Marino MV, Gulotta G, Komorowski AL. Fully robotic left hepatectomy for malignant tumor: technique and initial results. Updates Surg 2018; 71:129-135. [PMID: 29981056 DOI: 10.1007/s13304-018-0560-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/30/2018] [Indexed: 12/12/2022]
Abstract
Robotic liver surgery has been considered as a unique opportunity to overcome the traditional limitations of laparoscopy; thus, it can potentially extend the indications of minimally invasive liver surgery. From April 2015 to May 2017, 35 patients underwent fully robotic left hepatectomy. The mean operative time was 315 min (200-445 min) and the mean estimated blood loss was 245 ml (125-628 ml). Pringle maneuver was required in six cases. Cancer was the indication for surgery in all patients (14 liver metastases, 18 hepatocellular carcinomas and 3 cholangiocarcinomas). There were one to four lesions in a patient and the mean lesion size was 39.2 mm (15-85 mm). The average length of hospital stay was 6.5 days (5-14 days). Perioperative morbidity rate was 17.2%. Two patients underwent conversion to open surgery. The 90-day mortality rate was nil. The mean surgical resection margin was 12 (1-22) mm, and R0-resection was reached in 33 out of 35 cases. The robotic left hepatectomy provides interesting surgical outcomes and good oncologic adequacy. It can be safely applied for the management of liver malignancies.
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Affiliation(s)
- Marco Vito Marino
- Department of Emergency and General Surgery, Azienda Ospedaliera "Villa Sofia-Cervello", Salerno place 1, 90146, Palermo (PA), Italy.
| | - Gaspare Gulotta
- Department of Emergency and General Surgery, Policlinico "Paolo Giaccone", University Hospital, Giuffrè street 5, 90127, Palermo, Italy
| | - Andrzej Lech Komorowski
- Department of Surgical Oncology, Maria Sklodowska Curie Cancer Center Memorial Hospital, Garncarska street 11, 31-115, Krakow, Poland
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58
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Abu Hilal M, Aldrighetti L, Dagher I, Edwin B, Troisi RI, Alikhanov R, Aroori S, Belli G, Besselink M, Briceno J, Gayet B, D'Hondt M, Lesurtel M, Menon K, Lodge P, Rotellar F, Santoyo J, Scatton O, Soubrane O, Sutcliffe R, Van Dam R, White S, Halls MC, Cipriani F, Van der Poel M, Ciria R, Barkhatov L, Gomez-Luque Y, Ocana-Garcia S, Cook A, Buell J, Clavien PA, Dervenis C, Fusai G, Geller D, Lang H, Primrose J, Taylor M, Van Gulik T, Wakabayashi G, Asbun H, Cherqui D. The Southampton Consensus Guidelines for Laparoscopic Liver Surgery: From Indication to Implementation. Ann Surg 2018; 268:11-18. [PMID: 29064908 DOI: 10.1097/sla.0000000000002524] [Citation(s) in RCA: 437] [Impact Index Per Article: 72.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The European Guidelines Meeting on Laparoscopic Liver Surgery was held in Southampton on February 10 and 11, 2017 with the aim of presenting and validating clinical practice guidelines for laparoscopic liver surgery. BACKGROUND The exponential growth of laparoscopic liver surgery in recent years mandates the development of clinical practice guidelines to direct the speciality's continued safe progression and dissemination. METHODS A unique approach to the development of clinical guidelines was adopted. Three well-validated methods were integrated: the Scottish Intercollegiate Guidelines Network methodology for the assessment of evidence and development of guideline statements; the Delphi method of establishing expert consensus, and the AGREE II-GRS Instrument for the assessment of the methodological quality and external validation of the final statements. RESULTS Along with the committee chairman, 22 European experts; 7 junior experts and an independent validation committee of 11 international surgeons produced 67 guideline statements for the safe progression and dissemination of laparoscopic liver surgery. Each of the statements reached at least a 95% consensus among the experts and were endorsed by the independent validation committee. CONCLUSION The European Guidelines Meeting for Laparoscopic Liver Surgery has produced a set of clinical practice guidelines that have been independently validated for the safe development and progression of laparoscopic liver surgery. The Southampton Guidelines have amalgamated the available evidence and a wealth of experts' knowledge taking in consideration the relevant stakeholders' opinions and complying with the international methodology standards.
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Affiliation(s)
| | | | | | - Bjorn Edwin
- The Intervention Centre, Department of HBP surgery, Oslo University Hospital and Institute of Clinical Medicine, Oslo University, Oslo, Norway
| | | | | | | | | | | | | | - Brice Gayet
- Institut Mutualiste Montsouris, Paris, France
| | | | | | | | - Peter Lodge
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | | | | | | | | - Ronald Van Dam
- Maastricht University Medical Centre, Maastricht, Nehterlands
| | - Steve White
- Newcastle upon Tyne NHS Foundation Trust, Newcastle, UK
| | | | | | | | - Ruben Ciria
- University Hospital Reina, Sofia Cordoba, Spain
| | - Leonid Barkhatov
- The Intervention Centre, Department of HBP surgery, Oslo University Hospital and Institute of Clinical Medicine, Oslo University, Oslo, Norway
| | | | | | - Andrew Cook
- Southampton Clinical Trials Unit, University Hospital Southampton, Southampton, UK
| | - Joseph Buell
- Louisiana State University and Medical Center, New Orleans, LA
| | | | | | | | | | - Hauke Lang
- Mainz University Hospital, Mainz, Germany
| | | | | | | | | | | | - Daniel Cherqui
- Hepatobiliary Centre-Paul Brousse Hospital, Villejuif-Paris, France
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59
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Wong DJ, Wong MJ, Choi GH, Wu YM, Lai PB, Goh BKP. Systematic review and meta-analysis of robotic versus open hepatectomy. ANZ J Surg 2018; 89:165-170. [PMID: 29943881 DOI: 10.1111/ans.14690] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/13/2018] [Accepted: 04/17/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND To date, there are few studies comparing the outcomes of robotic hepatectomy (RH) versus open hepatectomy (OH). We report the first systematic review and meta-analysis comparing the outcomes of RH versus OH. METHODS A systemic review was performed of all comparative studies of RH versus OH that reported the perioperative outcome(s) of interest. RESULTS Seven retrospective cohort studies were included. There was no significant difference in patients' baseline characteristics. RH was associated with a longer operation time (mean difference (MD) 61.47 min; 95% confidence interval (CI) (7.03, 115.91); P = 0.03), shorter hospital stay (MD -2.57 days; 95% CI (-3.31, -1.82); P < 0.001), lower costs, less overall (risk ratio (RR) 0.63; 95% CI (0.46, 0.86); P = 0.004), minor (RR 0.64; 95% CI (0.43, 0.95); P = 0.03) and major (RR 0.45; 95% CI (0.22, 0.94); P = 0.03) post-operative complications compared to OH. CONCLUSION RH had superior perioperative outcomes and was not cost prohibitive compared to OH, but had longer operation times.
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Affiliation(s)
- Daniel J Wong
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore.,Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Michelle J Wong
- Medical Program, The University of Sydney, Sydney, New South Wales, Australia
| | - Gi Hong Choi
- Division of Hepatopancreatobiliary Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Yao Ming Wu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Paul B Lai
- Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore.,Duke-NUS Medical School, Singapore
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60
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Abstract
Robotic liver resection can overcome some of the limitations of laparoscopic liver surgery; therefore, it is a promising tool to increase the proportion of minimally invasive liver resections. The present article gives an overview of the current literature. Furthermore, the results of a nationwide survey on robotic liver surgery among hospitals in Germany with a DaVinci system used in general visceral surgery and the perioperative results of two German robotic centers are presented.
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61
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Caruso S, Patriti A, Ceccarelli G, Coratti A. Minimally invasive liver resection: has the time come to consider robotics a valid assistance? Hepatobiliary Surg Nutr 2018; 7:195-198. [PMID: 30046572 DOI: 10.21037/hbsn.2018.02.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Stefano Caruso
- Department of General Surgery and Surgical Specialties, Unit of General Surgery, "Santa Maria Annunziata" Hospital, Local Health Unit Center Tuscany Company, Florence, Italy
| | - Alberto Patriti
- Department of Surgery, Division of General Surgery, Hospitals of Pesaro and Fano, "Ospedali Riuniti Marche Nord" Hospital Company, Marche, Italy
| | - Graziano Ceccarelli
- Department of Medicine and General Surgery, Unit of Minimally Invasive and General Surgery, Local Health Unit South-East Tuscany Company, "San Donato" Hospital, Arezzo, Italy
| | - Andrea Coratti
- Division of Oncological and Robotic General Surgery, "Careggi" University Hospital, Largo Brambilla 3, Florence, Italy
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62
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Beard RE, Tsung A. Minimally Invasive Approaches for Surgical Management of Primary Liver Cancers. Cancer Control 2018; 24:1073274817729234. [PMID: 28975827 PMCID: PMC5937236 DOI: 10.1177/1073274817729234] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The benefits of minimally invasive approaches in oncologic surgery are
increasingly recognized, and laparoscopic liver surgery has become increasingly
widespread. In light of the complexity and technical challenges of hepatobiliary
procedures, robotic approaches are also employed. The utility, safety, and
oncologic integrity of these methods in the management of primary liver cancers
are reported. PubMed was used to search the medical literature for studies and
articles pertaining to laparoscopic and robotic liver surgery. Studies that
particularly addressed hepatocellular carcinoma and cholangiocarcinoma were
identified and reviewed. Laparoscopic liver surgery, including for major
resections, has been shown to be safe in experienced hands without any
compromise of oncologic outcomes for either hepatocellular carcinoma or
intrahepatic cholangiocarcinoma. Some studies show improved clinical outcomes
including shorter hospital stays and lower complication rates when compared to
open surgery, particularly for patients with cirrhosis. Robotic liver surgeries
seem to have equally acceptable clinical outcomes; however, there is limited
data regarding oncologic integrity and considerable additional expense.
Laparoscopic and robotic liver resections are both feasible and safe for the
management of primary liver tumors. Future studies should aim to clarify
specific indications and optimize applications of these approaches.
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Affiliation(s)
- Rachel E Beard
- 1 Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Allan Tsung
- 1 Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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63
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Goh BKP, Lee LS, Lee SY, Chow PKH, Chan CY, Chiow AKH. Initial experience with robotic hepatectomy in Singapore: analysis of 48 resections in 43 consecutive patients. ANZ J Surg 2018; 89:201-205. [PMID: 29512261 DOI: 10.1111/ans.14417] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/04/2018] [Accepted: 01/07/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Presently, the adoption of laparoscopic hepatectomy is rapidly increasingly worldwide. However, the application of robotic hepatectomy (RH) remains limited and its role remains undefined today. METHODS A retrospective review of 43 consecutive patients who underwent RH at two institutions in the Singapore Health Services Group. RESULTS Forty-three consecutive patients underwent 48 resections during the study period. Seven (16.3%) patients underwent major resections and seven (16.3%) underwent right posterior sectionectomies. Nineteen (44.2%) patients had tumours located in the difficult posterosuperior segments, five had multiple resections and three underwent repeat resections for recurrent tumours. RH was performed for malignant tumours in 32 (74%) patients and 16 (37.2%) had cirrhosis. Seven RH was performed with other concomitant procedures including three colectomies, three hilar lymphadenectomies and one portal vein ligation. The median operation time was 360 min (range 75-825) and the median blood loss was 300 mL (range 25-4500). There was one (2.3%) open conversion for bleeding. The median post-operative stay was 4 days (range 2-33) and there was one (2.3%) readmission. There was one (2.3%) major (>grade 2 morbidity) in a patient with concomitant anterior resection who underwent reoperation for anastomotic leak. There was no 90 day/in-hospital mortality. Comparison between RH for tumours in the anterolateral segments versus posterosuperior segments demonstrated no significant difference in perioperative outcomes. CONCLUSION Our initial experience demonstrated that RH is safe, feasible and associated with excellent post-operative outcomes. It can be performed successfully with low morbidity even for complex resections such as major hepatectomies, posterior sectionectomies, tumours in difficult posterosuperior segments and repeat liver resections.
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Affiliation(s)
- Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore.,Duke-NUS Graduate Medical School, Singapore
| | - Lip-Seng Lee
- Hepatopancreatobiliary Unit, Department of General Surgery, Changi General Hospital, Singapore
| | - Ser-Yee Lee
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore.,Duke-NUS Graduate Medical School, Singapore
| | - Pierce K H Chow
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore.,Duke-NUS Graduate Medical School, Singapore
| | - Chung-Yip Chan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore.,Duke-NUS Graduate Medical School, Singapore
| | - Adrian K H Chiow
- Hepatopancreatobiliary Unit, Department of General Surgery, Changi General Hospital, Singapore
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Miyashita K, Oude Vrielink T, Mylonas G. A cable-driven parallel manipulator with force sensing capabilities for high-accuracy tissue endomicroscopy. Int J Comput Assist Radiol Surg 2018. [PMID: 29516353 PMCID: PMC5953980 DOI: 10.1007/s11548-018-1717-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE Endomicroscopy (EM) provides high resolution, non-invasive histological tissue information and can be used for scanning of large areas of tissue to assess cancerous and pre-cancerous lesions and their margins. However, current robotic solutions do not provide the accuracy and force sensitivity required to perform safe and accurate tissue scanning. METHODS A new surgical instrument has been developed that uses a cable-driven parallel mechanism (CPDM) to manipulate an EM probe. End-effector forces are determined by measuring the tensions in each cable. As a result, the instrument allows to accurately apply a contact force on a tissue, while at the same time offering high resolution and highly repeatable probe movement. RESULTS 0.2 and 0.6 N force sensitivities were found for 1 and 2 DoF image acquisition methods, respectively. A back-stepping technique can be used when a higher force sensitivity is required for the acquisition of high quality tissue images. This method was successful in acquiring images on ex vivo liver tissue. CONCLUSION The proposed approach offers high force sensitivity and precise control, which is essential for robotic EM. The technical benefits of the current system can also be used for other surgical robotic applications, including safe autonomous control, haptic feedback and palpation.
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Affiliation(s)
- Kiyoteru Miyashita
- HARMS Lab, Department of Surgery and Cancer, Imperial College London, 3rd Floor Paterson Wing, 20 South Wharf Road, W2 1PF, London, UK
| | - Timo Oude Vrielink
- HARMS Lab, Department of Surgery and Cancer, Imperial College London, 3rd Floor Paterson Wing, 20 South Wharf Road, W2 1PF, London, UK.
| | - George Mylonas
- HARMS Lab, Department of Surgery and Cancer, Imperial College London, 3rd Floor Paterson Wing, 20 South Wharf Road, W2 1PF, London, UK
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65
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Wang WH, Kuo KK, Wang SN, Lee KT. Oncological and surgical result of hepatoma after robot surgery. Surg Endosc 2018; 32:3918-3924. [PMID: 29488090 DOI: 10.1007/s00464-018-6131-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 02/23/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Most liver resections are currently performed using an open approach. Robotic hepatectomy has been suggested as a safe and effective approach for hepatocellular carcinoma; however, studies regarding oncological and surgical outcomes are still limited. Accordingly, we performed this study to compare the surgical and oncological outcomes between robotic and open approaches. METHODS Between June, 2013 and July, 2016, a total of 63 HCC patients undergoing robotic hepatectomy, and 177 patients undergoing open hepatectomy were included in this study to assess the surgical and oncological outcomes after hepatectomy. The data of demographic, clinical features, hepatitis profile, tumor characters, TNM stage, surgical type, pathological outcomes, and postoperative results were collected prospectively and analyzed retrospectively. RESULTS The demographic and clinical features of patients with HCC in both groups were statistically comparable. The robotic group had longer operative times (296 ± 84 vs. 182 ± 51 min, p = 0.032). The postoperative complications rate was slightly lower in the robotic group (11.1 vs. 15.3%, p = 0.418). The rate of Ro resection was similar in both groups (93.7 vs. 96%, p = 0.56). The length of hospital stay was significantly shorter in the robotic group (6.21 ± 2.06 vs. 8.18 ± 6.99 days, p = 0.001). The overall recurrence rate of HCC was lower in the robotic group (27 vs. 37.3%, p = 0.140). The 1, 2, 3 year disease-free survival rates were 72.5, 64.3, and 61.6%, respectively, for the open group, while they were 77.8, 71.9, and 71.9%, respectively, for the robotic group, (p = 0.325). The 1, 2, 3 year overall survival rates were 95.4, 92.3, and 92.3%, respectively, for the open group, while they were 100, 97.7, and 97.7%, respectively, for the robotic group (p = 0.137). CONCLUSION Robotic surgery is a safe and feasible procedure for liver resection in selected patients. The oncological and surgical outcomes of robotic hepatectomy were comparable to open surgery. The robotic hepatectomy carried significantly shorter length of hospital stay.
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Affiliation(s)
- Wen-Hsiuan Wang
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzy-you 1st Rd, Kaohsiung, 807, Taiwan
| | - Kung-Kai Kuo
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzy-you 1st Rd, Kaohsiung, 807, Taiwan
| | - Shen-Nien Wang
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzy-you 1st Rd, Kaohsiung, 807, Taiwan
| | - King-Teh Lee
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzy-you 1st Rd, Kaohsiung, 807, Taiwan.
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Park JI, Kim KH, Kim HJ, Cherqui D, Soubrane O, Kooby D, Palanivelu C, Chan A, You YK, Wu YM, Chen KH, Honda G, Chen XP, Tang CN, Kim JH, Koh YS, Yoon YI, Cheng KC, Duy Long TC, Choi GH, Otsuka Y, Cheung TT, Hibi T, Kim DS, Wang HJ, Kaneko H, Yoon DS, Hatano E, Choi IS, Choi DW, Huang MT, Kim SG, Lee SG. Highlights of the Third Expert Forum of Asia-Pacific Laparoscopic Hepatectomy; Endoscopic and Laparoscopic Surgeons of Asia (ELSA) Visionary Summit 2017. Ann Hepatobiliary Pancreat Surg 2018. [PMID: 29536050 PMCID: PMC5845605 DOI: 10.14701/ahbps.2018.22.1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The application of laparoscopy for liver surgery is rapidly increasing and the past few years have demonstrated a shift in paradigm with a trend towards more extended and complex resections. The development of instruments and technical refinements with the effective use of magnified caudal laparoscopic views have contributed to the ability to overcome the limitation of laparoscopic liver resection. The Endoscopic and Laparoscopic Surgeons of Asia (ELSA) Visionary Summit 2017 and the 3rd Expert Forum of Asia-Pacific Laparoscopic Hepatectomy organized hepatobiliary pancreatic sessions in order to exchange surgical tips and tricks and discuss the current status and future perspectives of laparoscopic hepatectomy. This report summarizes the oral presentations given at the 3rd Expert Forum of Asia-Pacific Laparoscopic Hepatectomy.
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Affiliation(s)
- Jeong-Ik Park
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ki-Hun Kim
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hong-Jin Kim
- Department of Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Daniel Cherqui
- Hepatobiliary Center, Paul Brousse Hospital, University Paris Sud, Villejuif, France
| | - Olivier Soubrane
- Department of HPB Surgery and Liver Transplant, Beaujon Hospital, University Denis Diderot, Paris, France
| | - David Kooby
- Division of Surgical Oncology, Department of Surgery, Emory Saint Joseph's Hospital, Emory University School of Medicine, Atlanta, GA, USA
| | - Chinnusamy Palanivelu
- Gastrointestinal Surgery and Advanced Center for Minimal Access Surgery, GEM Hospital & Research Center, Coimbatore, TN, India
| | - Albert Chan
- Division of Hepatobiliary & Pancreatic Surgery and Liver Transplantation, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Young Kyoung You
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yao-Ming Wu
- Department of Surgery, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Kuo-Hsin Chen
- Department of Surgery, Far-Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Goro Honda
- Department of HBP Surgery, Tokyo Metropolitan Center and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Xiao-Ping Chen
- Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chung-Ngai Tang
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - Ji Hoon Kim
- Department of Surgery, Eulji Hospital, Eulji University College of Medicine, Daejeon, Korea
| | - Yang Seok Koh
- Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Young-In Yoon
- Division of Hepatobiliarypancreatic Surgery and Liver Transplantation, Department of Surgery, Korea University Medical Center, Korea University Medical College, Seoul, Korea
| | - Kai Chi Cheng
- Department of Surgery, Kwong Wah Hospital, Hong Kong
| | - Tran Cong Duy Long
- Department of General Surgery, University Medical Center, Ho Chi Minh City, Vietnam
| | - Gi Hong Choi
- Division of Hepatopancreaticobiliary Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Yuichiro Otsuka
- Division of General and Gastroenterological Surgery, Department of Surgery, Toho University Faculty of Medicine, Tokyo, Japan
| | - Tan To Cheung
- Division of Hepatobiliary & Pancreatic Surgery and Liver Transplantation, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Taizo Hibi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Dong-Sik Kim
- Division of Hepatobiliarypancreatic Surgery and Liver Transplantation, Department of Surgery, Korea University Medical Center, Korea University Medical College, Seoul, Korea
| | - Hee Jung Wang
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Hironori Kaneko
- Division of General and Gastroenterological Surgery, Department of Surgery, Toho University Faculty of Medicine, Tokyo, Japan
| | - Dong-Sup Yoon
- Department of Surgery, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Etsuro Hatano
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - In Seok Choi
- Department of Surgery, Konyang University Hospital, Konynag University, Daejeon, Korea
| | - Dong Wook Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ming-Te Huang
- Department of Surgery, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sang Geol Kim
- Department of Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sung-Gyu Lee
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Robotic-Assisted Versus Laparoscopic Left Lateral Sectionectomy: Analysis of Surgical Outcomes and Costs by a Propensity Score Matched Cohort Study. World J Surg 2017; 41:516-524. [PMID: 27743071 DOI: 10.1007/s00268-016-3736-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND After comparing with open approach, left lateral sectionectomy (LLS) has become standard in terms of short-term outcomes without jeopardizing long-term survival when performed for malignancy. The aim of this study was to compare the short-term and economic outcomes of laparoscopic (L-LLS) and robotic (R-LLS) LLS. METHODS All consecutive patients who underwent L-LLS or R-LLS from 1997 to 2014 were analyzed. Short-term and economic outcomes were compared between the two groups using a propensity score matching (PSM). RESULTS Ninety-six consecutive cases of LLS were performed using the laparoscopic (80 cases; 83 %) or robotic (16 cases; 17 %) approach. The two groups were similar for operative and surgical outcomes. Operation time was similar in the R-LLS compared to the L-LLS group (190 vs. 162 min; p = 0.10). Perioperative costs were higher (1457 € vs. 576 €; p < 0.0001) in the R-LLS group than in the L-LLS group; however, postoperative costs were similar between the two groups (4065 € in the R-LLS group vs. 5459 € in the L-LLS group; p = 0.30). Total costs were similar between the two groups (5522 € in the R-LLS group vs. 6035€ in the L-LLS group; p = 0.70). The PSM included 14 patients for each group. Surgical and economic outcomes remained similar after PSM, except for total operating time which was significantly longer in the R-LLS group than in the L-LLS group. CONCLUSIONS Even if feasible and safe, the robotic approach does not seem so far to offer additional benefit in terms of intra- and postoperative outcomes over the laparoscopic approach in patients requiring LLS. Total costs associated with the R-LLS group are not greater than that associated with the L-LLS group, which is the standard of care so far.
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Goh BK, Lee SY, Chan CY, Wong JS, Cheow PC, Chung AY, Ooi LL. Early experience with robot-assisted laparoscopic hepatobiliary and pancreatic surgery in Singapore: single-institution experience with 20 consecutive patients. Singapore Med J 2017; 59:133-138. [PMID: 28983577 DOI: 10.11622/smedj.2017092] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Experience with robot-assisted laparoscopic (RAL) hepatobiliary and pancreatic (HPB) surgery remains limited worldwide. In this study, we report our early experience with RAL HPB surgery in Singapore. METHODS A retrospective review of the first 20 consecutive patients who underwent RAL HPB surgery at a single institution over a 34-month period from February 2013 to November 2015 was conducted. The 20 cases were performed by three principal surgeons, of which 17 (85.0%) were performed by a single surgeon. RESULTS The median age of patients was 56 (range 22-75) years and median tumour size was 4.0 (range 1.2-7.5) cm. The surgeries performed included left-sided pancreatectomies (n = 10), hepatectomies (n = 7), triple bypass with bile duct exploration for obstructing pancreatic head cancer with choledocholithiasis (n = 1), cholecystectomy for Mirizzi's syndrome (n = 1) and gastric resection for gastrointestinal stromal tumour (n = 1). The median operation time was 445 (range 80-825) minutes and median blood loss was 350 (range 0-1,200) mL. There was only 1 (5%) open conversion. There were 2 (10.0%) major morbidities (> Grade II on the Clavien-Dindo classification) and no 30-day/in-hospital mortalities. There was no reoperation for postoperative complications. The median postoperative stay was 5.5 (range 3-22) days. CONCLUSION Our initial experience confirms the feasibility and safety of RAL HPB surgery.
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Affiliation(s)
- Brian Kp Goh
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.,Duke-NUS Medical School, Singapore
| | - Ser-Yee Lee
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore
| | - Chung-Yip Chan
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore
| | - Jen-San Wong
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore
| | - Peng-Chung Cheow
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore
| | - Alexander Yf Chung
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore
| | - London Lpj Ooi
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore
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Towards standardized robotic surgery in gastrointestinal oncology. Langenbecks Arch Surg 2017; 402:1003-1014. [DOI: 10.1007/s00423-017-1623-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 09/10/2017] [Indexed: 02/07/2023]
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Hu L, Yao L, Li X, Jin P, Yang K, Guo T. Effectiveness and safety of robotic-assisted versus laparoscopic hepatectomy for liver neoplasms: A meta-analysis of retrospective studies. Asian J Surg 2017; 41:401-416. [PMID: 28912048 DOI: 10.1016/j.asjsur.2017.07.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/30/2017] [Accepted: 07/25/2017] [Indexed: 02/07/2023] Open
Abstract
This meta-analysis aimed to investigate the effectiveness and safety of RAH and LLR for liver neoplasms. A systematic search was performed in PubMed, EMbase, the Cochrane Library, Web of science, and China Biology Medicine disc up to July 2016 for studies that provided comparisons between the surgical outcomes of RAH and LLR for liver neoplasms. WMD, OR and 95% CI were calculated and data combined using the random-effect model. The quality of the evidence was assessed using GRADE methods. A total of 17 studies were included in the meta-analysis, in which 487 patients were in the RAH group and 902 patients were in the LLR group. The meta-analysis results indicated: compared to LLR, RAH was associated with more estimated blood loss, longer operative time, and longer time to first nutritional intake (p < 0.05). There was no significant difference in length of hospital stay, conversion rate during operation, R0 resection rate, complications and mortality (p > 0.05). Three studies reported the total cost, and the result showed a higher cost in the RAH group when compared with the LLR group (p < 0.05). This meta-analysis indicated that RAH and LLR display similar effectiveness and safety in hepatectomy. Considering the lack of high quality original studies, prospective clinical trials should be conducted to provide strong evidence for clinical guidelines formation, and the insurance coverage policies should be established to promote the application of robotic surgery in the future.
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Affiliation(s)
- Lidong Hu
- Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou 730000, People's Republic of China; Department of General Surgery, Gansu Province People's Hospital, Lanzhou 730000, People's Republic of China
| | - Liang Yao
- Institution of Clinical Research and Evidence Based Medicine, Gansu Province People's Hospital, Lanzhou 730000, People's Republic of China
| | - Xiaofei Li
- Department of General Surgery, Gansu Province People's Hospital, Lanzhou 730000, People's Republic of China; Department of Clinical Medicine, Ningxia Medical University, Yinchuan 750004, People's Republic of China
| | - Penghui Jin
- Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou 730000, People's Republic of China; Department of General Surgery, Gansu Province People's Hospital, Lanzhou 730000, People's Republic of China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, People's Republic of China.
| | - Tiankang Guo
- Department of General Surgery, Gansu Province People's Hospital, Lanzhou 730000, People's Republic of China.
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Li X, Wang T, Yao L, Hu L, Jin P, Guo T, Yang K. The safety and effectiveness of robot-assisted versus laparoscopic TME in patients with rectal cancer: A meta-analysis and systematic review. Medicine (Baltimore) 2017; 96:e7585. [PMID: 28723798 PMCID: PMC5521938 DOI: 10.1097/md.0000000000007585] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The aim of this study was to assess the safety and effectiveness of robotic-assisted versus laparoscopic total mesorectal excision (TME) in patients with rectal cancer. METHODS We systematically searched PubMed, EMBASE, Cochrane library, Web of science, and Chinese Biomedical Literature Database up to July 2016 to identify case-controlled studies that compared robotic TME (RTME) with laparoscopic TME (LTME) for rectal cancer. GRADE was used to interpret the primary outcomes of this meta-analysis. RESULTS We included 17 case-control studies (3601 participants: 1726 underwent RTME and 1875 LTME for rectal cancer) that compared RTME with LTME for rectal cancer. We found no statistically significant differences between techniques for local recurrence [odds ratio (OR) = 0.68, P = .216] and overall survival at 3 years (OR = 0.71, P = 1.140), complications (OR = 1.02, P = .883), positive circumferential resection margin (PCRM) (OR = 0.80, P = .256), the first passing flatus [weighted mean difference (WMD) = -0.11, P = .130], reoperation (OR = 0.66, P = .080), estimated blood loss (EBL) (WMD = -12.45, P = .500), and length of stay in hospital (LOS) (WMD = -0.69, P = .089). Compared with LTME, RTME was associated with lower rate of conversion (OR = 0.35, P < .001), urinary retention (OR = 0.41, P = .025), and longer operative time (WMD = 57.43, P < .001). The overall quality of evidence was poor in all outcomes. CONCLUSION RTME in patients with rectal cancer was associated with a lower rate of conversion and less incidence of urinary retention. Generally, operative time in RTME was significantly longer than in LTME. The long-term oncological and function outcomes of RTME seem to be equivalent with LTME. Therefore, analysis of current studies to date did not indicate a major benefit of RTME over LTME.
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Affiliation(s)
- Xiaofei Li
- Department of General Surgery, Gansu Province People's HospitalGansu
- School of Clinical Medical Sciences, Ningxia Medical UniversityYinchuan
| | | | - Liang Yao
- Institution of Clinical Research and Evidence Based Medicine, Gansu Province People's Hospital
| | - Lidong Hu
- Department of General Surgery, Gansu Province People's HospitalGansu
- Institution of Clinical Research and Evidence Based Medicine, Gansu Province People's Hospital
| | - Penghui Jin
- School of Clinical Medical Sciences, Gansu University of Traditional Chinese Medicine
| | - Tiankang Guo
- Department of General Surgery, Gansu Province People's HospitalGansu
- School of Clinical Medical Sciences, Ningxia Medical UniversityYinchuan
| | - Kehu Yang
- Institution of Clinical Research and Evidence Based Medicine, Gansu Province People's Hospital
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
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Zureikat AH, Borrebach J, Pitt HA, Mcgill D, Hogg ME, Thompson V, Bentrem DJ, Hall BL, Zeh HJ. Minimally invasive hepatopancreatobiliary surgery in North America: an ACS-NSQIP analysis of predictors of conversion for laparoscopic and robotic pancreatectomy and hepatectomy. HPB (Oxford) 2017; 19:595-602. [PMID: 28400087 DOI: 10.1016/j.hpb.2017.03.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 02/17/2017] [Accepted: 03/15/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Procedural conversion rates represent an important aspect of the feasibility of minimally invasive surgical (MIS) approaches. This study aimed to outline the rates and predictors of procedural completion/conversion for MIS hepatectomy and pancreatectomy. METHODS All 2014 ACS-NSQIP laparoscopic and robotic hepatectomy and pancreatectomy procedures were identified and grouped into pure, open assist, or unplanned conversion to open. Risk adjusted multinomial logistic regression models were generated with completion (Pure) set as the primary outcome. RESULTS 1667 (laparoscopic = 1360, robotic = 307) resections were captured. After risk adjustment, robotic DP was associated with similar open assist (relative risk ratio -1.9%, P = 0.602), but lower unplanned conversion (-8.2%, P = 0.004) and open assist + unplanned conversion (-10.1%, P = 0.015) compared to laparoscopic DP; while robotic PD was associated with lower open assist (-22.2%, P < 0.001), unplanned conversions (-15%, P = 0.006) and open assist + unplanned conversions (-37.2, P < 0.001) compared to laparoscopic PD. The robotic and laparoscopic approaches to hepatectomy were not associated with differences in pure MIS completion rates (P = NS) after risk adjustment. CONCLUSIONS The robotic approach to pancreatectomy was associated with higher rates of pure MIS completion compared to laparoscopy, whereas no difference in MIS completion rates was noted for robotic versus laparoscopic hepatectomy.
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Affiliation(s)
- Amer H Zureikat
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Jeffrey Borrebach
- Wolff Center of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Henry A Pitt
- Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Douglas Mcgill
- Wolff Center of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Melissa E Hogg
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Vanessa Thompson
- American College of Surgeons - National Surgical Quality Improvement Program, Chicago, IL, USA
| | - David J Bentrem
- Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Bruce L Hall
- American College of Surgeons - National Surgical Quality Improvement Program, Chicago, IL, USA; Department of Surgery and Olin Business School, Washington University in St Louis, St Louis, MO, USA; BJC Healthcare, St Louis, MO, USA
| | - Herbert J Zeh
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Yan Y, Cai X, Geller DA. Laparoscopic Liver Resection: A Review of Current Status. J Laparoendosc Adv Surg Tech A 2017; 27:481-486. [DOI: 10.1089/lap.2016.0620] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Yihe Yan
- Division of General Surgery, Department of Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Xiaoyong Cai
- Division of General Surgery, Department of Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - David A. Geller
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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Goja S, Singh MK, Soin AS. Robotics in hepatobiliary surgery-initial experience, first reported case series from India. Int J Surg Case Rep 2017; 33:16-20. [PMID: 28262591 PMCID: PMC5334495 DOI: 10.1016/j.ijscr.2017.02.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 02/13/2017] [Accepted: 02/13/2017] [Indexed: 01/01/2023] Open
Abstract
Utility of robotic system for heterogenous mix of hepatobiliary cases. Ability of robotic system to perform complex hepatobiliary cases. Advantages of minimal access surgery but at a higher cost.
Introduction Robotic surgical system's ability to perform complex hepatobiliary surgeries is gaining momentum with outcomes similar to open surgery and advantages of minimal access surgery. The authors present their initial experience of a heterogenous spectrum of robotic hepatobiliary cases and the first reported case series from India. Methods Retrospective review of hepatobiliary cases done robotically from February 2015 to January 2016 was done. Results The series has ten patients; with median age of 45 years (range 15–72). Etiologies were choledochal cyst type IVa, benign lower end common bile duct stricture (biliary reconstruction group); incidental gallbladder carcinoma, hepatocellular carcinoma, recurrent pyogenic cholangitis, polycystic liver disease, hemangioma, liver metastases, hydatid cyst (resection group). Median operative duration was 510 min; one patient needed intra-operative blood transfusion and there were no conversions to open surgery. One patient developed bile leak which was managed by biliary stenting and another thrombotic thrombocytopenic purpura during post-operative period. Median length of hospital stay was 6 days with average cost of robotic surgery being $1700 USD more for major hepatectomy and $900 USD more for biliary reconstruction compared to open procedure. Conclusion This initial series adds to existing data on the feasibility of robotic hepatobiliary cases with inherent advantages of minimal invasive surgery, however with limitation of availability and use of devices like cavitron ultrasonic surgical aspirator (CUSA) and higher operative cost.
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Affiliation(s)
- S Goja
- Medanta Institute of Liver Diseases and Transplantation, Medanta-The Medicity, Delhi, NCR, India.
| | - M K Singh
- Medanta Institute of Liver Diseases and Transplantation, Medanta-The Medicity, Delhi, NCR, India
| | - A S Soin
- Medanta Institute of Liver Diseases and Transplantation, Medanta-The Medicity, Delhi, NCR, India
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Morel P, Jung M, Cornateanu S, Buehler L, Majno P, Toso C, Buchs NC, Rubbia-Brandt L, Hagen ME. Robotic versus open liver resections: A case-matched comparison. Int J Med Robot 2017; 13. [PMID: 28058770 DOI: 10.1002/rcs.1800] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 10/12/2016] [Accepted: 11/15/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Most hepatic resections are currently performed using an open approach. Robotic surgery might enable the transition of these procedures to minimally invasive surgery. METHODS Pre-, peri- and post-operative data of all patients who underwent a liver resection from 2009/2012 to 2001/2015, were collected prospectively. All robotic resection patients were matched 1:1 to patients who underwent open surgery. Pre- and perioperative data, up to 30 days, were analyzed. RESULTS Sixteen robotic and open hepatic resections were identified. Fewer complication events and shorter lengths of stay (LOS, 7.9 versus 11 days, P = 0.0603) were observed for robotic resections. Length of stay in the intermediate care unit (IMC) was shorter after the robotic procedure (10 h vs 16.6 h, P = 0.0699). Operating room (OR) time was significantly longer in the robotic resection cohort (352.8 vs 239.6 min, P = 0.0215). All tumor margins were negative. CONCLUSIONS This preliminary comparison demonstrates the general feasibility of minor robotic liver resection in selected cases.
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Affiliation(s)
- Philippe Morel
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Minoa Jung
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Sorina Cornateanu
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Leo Buehler
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Pietro Majno
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Christian Toso
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Nicolas C Buchs
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Laura Rubbia-Brandt
- Division of Pathology, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Monika E Hagen
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
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76
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Chen PD, Wu CY, Hu RH, Chen CN, Yuan RH, Liang JT, Lai HS, Wu YM. Robotic major hepatectomy: Is there a learning curve? Surgery 2016; 161:642-649. [PMID: 27884614 DOI: 10.1016/j.surg.2016.09.025] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 09/12/2016] [Accepted: 09/17/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Robotic hepatectomy has been suggested as a safe and effective management of liver disease. However, no large case series have documented the learning curve for robotic major hepatectomy. METHOD We conducted a retrospective study for robotic major hepatectomy performed by the same operative team between January 2012 and October 2015 and evaluated the learning curve for operation time using the cumulative sum method, presented as cumulative sumoperation time. RESULTS Overall, there were 183 robotic hepatectomies, 92 of which were performed in patients who underwent robotic major hepatectomy: left hemihepatectomy was performed in 32 (34.8%) patients, right hemihepatectomy in 41 (44.6%), left trisectionectomy in 3 (3.3%), right trisectionectomy in 6 (6.5%), and 8-5-4 trisegmentectomy in 10 (10.8%). The median duration of surgery was 434 minutes (142-805 minutes) and the median blood loss was 195 mL (50-2,000 mL). Fifty-nine percent of patients had malignancies, and those with advanced stages of cancer had more blood loss during an operation. The cumulative sumoperation time model of robotic major hepatectomy suggested that the learning curve comprised 3 characteristic phases: initial (phase 1, 15 patients), intermediate (phase 2, 25 patients), and mature (phase 3, 52 patients). The learning effects were underlined by shorter operation time and hospital stay after phase 1 and less blood loss after phase 2. CONCLUSION This is the largest series regarding robotic major hepatectomy. Our findings suggest that a solid training program based on the learning curve should be considered for beginners of robotic hepatectomy. Participants should evaluate the evolution of our minimally invasive hepatectomy before considering our robotic experience.
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Affiliation(s)
- Po-Da Chen
- Department of Surgery, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | - Chao-Yin Wu
- Department of Surgery, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | - Rey-Heng Hu
- Department of Surgery, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | - Chiung-Nien Chen
- Department of Surgery, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | - Ray-Hwang Yuan
- Department of Surgery, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | - Jin-Tung Liang
- Department of Surgery, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | - Hong-Shiee Lai
- Department of Surgery, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-Ming Wu
- Department of Surgery, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan.
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Giulianotti PC, Bianco FM, Daskalaki D, Gonzalez-Ciccarelli LF, Kim J, Benedetti E. Robotic liver surgery: technical aspects and review of the literature. Hepatobiliary Surg Nutr 2016; 5:311-21. [PMID: 27500143 DOI: 10.21037/hbsn.2015.10.05] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Minimally invasive surgery for liver resections has a defined role and represents an accepted alternative to open techniques for selected cases. Robotic technology can overcome some of the disadvantages of the laparoscopic technique, mainly in the most complex cases. Precise dissection and microsuturing is possible, even in narrow operative fields, allowing for a better dissection of the hepatic hilum, fine lymphadenectomy, and biliary reconstruction even with small bile ducts and easier bleeding control. This technique has the potential to allow for a greater number of major resections and difficult segmentectomies to be performed in a minimally invasive fashion. The implementation of near-infrared fluorescence with indocyanine green (ICG) also allows for a more accurate recognition of vascular and biliary anatomy. The perspectives of this kind of virtually implemented imaging are very promising and may be reflected in better outcomes. The overall data present in current literature suggests that robotic liver resections are at least comparable to both open and laparoscopic surgery in terms of perioperative and postoperative outcomes. This article provides technical details of robotic liver resections and a review of the current literature.
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Affiliation(s)
- Pier Cristoforo Giulianotti
- Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL 60612, USA
| | - Francesco Maria Bianco
- Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL 60612, USA
| | - Despoina Daskalaki
- Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL 60612, USA
| | - Luis Fernando Gonzalez-Ciccarelli
- Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL 60612, USA
| | - Jihun Kim
- Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL 60612, USA
| | - Enrico Benedetti
- Division of Transplantation, Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL 60612, USA
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Chen XP, Pan M. Precise diagnosis and treatment of hepatolithiasis. Shijie Huaren Xiaohua Zazhi 2016; 24:3112-3118. [DOI: 10.11569/wcjd.v24.i20.3112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatolithiasis is a complex condition and the lesion is extensive. It is necessary to introduce the notion of precise surgery during the diagnosis and treatment of hepatolithiasis because the commonly used clinical methods have their limitations. A variety of technical means should be comprehensively applied to improve the levels of precise diagnosis and treatment, and individualized treatment strategy should be used. In addition, surgeons must attach great importance to the latest achievements of precise medicine, biomedical and intelligent technology.
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Yegin EG, Oymaci E, Karatay E, Coker A. Progress in surgical and nonsurgical approaches for hepatocellular carcinoma treatment. Hepatobiliary Pancreat Dis Int 2016; 15:234-56. [PMID: 27298100 DOI: 10.1016/s1499-3872(16)60097-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is a complex and heterogeneous malignancy, frequently occurs in the setting of a chronically diseased organ, with multiple confounding factors making its management challenging. HCC represents one of the leading causes of cancer-related mortality globally with a rising trend of incidence in some of the developed countries, which indicates the need for better surgical and nonsurgical management strategies. DATA SOURCES PubMed database was searched for relevant articles in English on the issue of HCC management. RESULTS Surgical resection represents a potentially curative option for appropriate candidates with tumors detected at earlier stages and with well-preserved liver function. The long-term outcome of surgery is impaired by a high rate of recurrence. Surgical approaches are being challenged by local ablative therapies such as radiofrequency ablation and microwave ablation in selected patients. Liver transplantation offers potential cure for HCC and also correction of underlying liver disease, and minimizes the risk of recurrence, but is reserved for patients within a set of criteria proposed for a prudent allocation in the shortage of donor organs. Transcatheter locoregional therapies have become the palliative standard allowing local control for intermediate stage patients with noninvasive multinodular or large HCC who are beyond the potentially curative options. The significant survival benefit with the multikinase inhibitor sorafenib for advanced HCC has shifted the direction of research regarding systemic treatment toward molecular therapies targeting the disregulated pathways of hepatocarcinogenesis. Potential benefit is suggested from simultaneous or sequential multimodal therapies, and optimal combinations are being investigated. Despite the striking progress in preclinical studies of HCC immunotherapy and gene therapy, extensive clinical trials are required to achieve successful clinical applications of these innovative approaches. CONCLUSION Treatment decisions have become increasingly complex for HCC with the availability of multiple surgical and nonsurgical therapeutic options and require a comprehensive, multidisciplinary approach.
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Affiliation(s)
- Ender Gunes Yegin
- Department of Gastroenterology, Bozyaka Training and Research Hospital, Izmir 35170, Turkey.
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Abstract
Minimally invasive surgery has been cautiously introduced in surgical oncology over the last two decades due to a concern of compromised oncological outcomes. Recently, it has been adopted in liver surgery for colorectal metastases. Colorectal cancer is a major cause of cancer-related death in the USA. In addition, liver metastasis is the most common site of distant disease and its resection improves survival. While open resection was the standard of care, laparoscopic liver surgery has become the standard of care for minor liver resections. Laparoscopic liver surgery provides equivalent oncological outcomes with better perioperative results compared to open liver surgery. Robotic liver surgery has been introduced as it is believed to overcome some of the limitations of laparoscopy. Finally, laparoscopic radio-frequency ablation and microwave coagulation can be used as adjuncts in minimally invasive surgery to complement or replace surgical resection when not possible.
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Xu J, Qin X. Expert consensus on robotic surgery for colorectal cancer (2015 edition). CHINESE JOURNAL OF CANCER 2016; 35:23. [PMID: 26916742 PMCID: PMC4768422 DOI: 10.1186/s40880-016-0085-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 12/29/2015] [Indexed: 02/08/2023]
Affiliation(s)
- Jianmin Xu
- Department of General surgery, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.
| | - Xinyu Qin
- Department of General surgery, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.
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