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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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Hepatobilio-pancreatic robotic surgery: initial experience from a single center institute. J Robot Surg 2016; 11:355-365. [PMID: 28039607 DOI: 10.1007/s11701-016-0663-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 12/04/2016] [Indexed: 02/07/2023]
Abstract
The use of robotic surgery in the hepatobilio-pancreatic (HBP) field is still limited. Our aim is to present our early experience of robotic liver resection. A retrospective review of robotic pancreatic and liver resection was performed at Sanchinarro University hospital from October 2010 to April 2016. Since the beginning of the robotic program in our center, 22 hepatic procedures and 45 pancreatic robotic procedures have been performed. Of the 21 patients subjected to liver resection, 13 (65%) were for malignancy. There were two left hepatectomies, one right hepatectomy, one associated liver partition and portal vein ligation staged procedure (both steps by robotic approach), three bisegmentectomies and three segmentectomies, eight wedge resections, and three pericystectomies. The mean operating time was 282 min. The overall conversion rate and postoperative complication rate were 4.7 and 19%, respectively. The mean length of hospital stay was 13.4 days (range 4-64 days). Of the 45 patients subjected to pancreatic resection, 22 were male and 23 female. The average age of all patients was 62 years (range 31-82 years). The mean operating room (OR) time was 370 min (120-780 min). Among the procedures performed were 15 pancreatico-duodenectomies, 19 distal pancreatectomies, and 11 enucleations. All procedures in the HBP area were R0. Our early experience shows that robotic surgery is a safe and feasible procedure in the HBP area. The complication and mortality rates are comparable to those of open surgery, but with the advantages of minimally invasive surgery.
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Robotic Liver Surgery: Early Experience From a Single Surgical Center. Surg Laparosc Endosc Percutan Tech 2016; 26:66-71. [PMID: 26836628 DOI: 10.1097/sle.0000000000000227] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION The use of robotic surgery in liver resection is still limited. Our aim is to present our early experience of robotic liver resection. MATERIALS AND METHODS It is a retrospective review of Sanchinarro University hospital experience of robotic liver resection performed from 2011 to 2014. Clinicopathologic characteristics, and perioperative and postoperative outcomes were recorded and analyzed. RESULTS Twenty-one procedures have been performed and 13 (65%) of them were for malignancy. There were 2 left hepatectomies, 1 right hepatectomy, 1 associated liver partition and portal vein ligation staged procedure (both steps by robotic approach), 1 bisegmentectomy and 3 segmentectomies, 9 wedge resections, and 3 pericystectomies. The mean operating time was 282 minutes (range, 90 to 540 min). Overall conversion rate and postoperative complication rate were 4.7% and 19%, respectively. The mean length of hospital stay was 13.4 days (range, 4 to 64 d). CONCLUSION From our early experience, robotic liver surgery is a safe and feasible procedure, especially for major hepatectomies.
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Abstract
Surgery using a robotic platform is expanding rapidly today, with a notable surge since its authorization on the international medical market by the US Food and Drug Administration in 2000. The first hepatectomy by a robotic approach was reported in 2002, 10 years after the first laparoscopic hepatectomy. Yet, in hepatic surgery, series are scarce and the lack of relevant data in the literature is an obstacle to the development of robot-assisted laparoscopic hepatectomy (RALH). Based on a review of the literature, this update focuses on current indications, short-term and oncologic outcomes following RALH.
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Vitali GC, Laurent A, Terraz S, Majno P, Buchs NC, Rubbia-Brandt L, Luciani A, Calderaro J, Morel P, Azoulay D, Toso C. Minimally invasive surgery versus percutaneous radio frequency ablation for the treatment of single small (≤3 cm) hepatocellular carcinoma: a case-control study. Surg Endosc 2015; 30:2301-7. [PMID: 26534770 DOI: 10.1007/s00464-015-4295-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 05/26/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with single small hepatocellular carcinoma (HCC) can be managed by surgical resection or radio frequency ablation (RFA), with similar recurrence and survival rates. Recently, minimally invasive surgery (MIS) has been introduced in liver surgery, and the advantage/drawback balance between surgery and RFA needs reassessment. METHODS Patients with Child-Pugh class A or B cirrhosis, and with single 1-3 cm HCC, undergoing MIS (laparoscopic or robot-assisted) or RFA from July 1998 to December 2012 were compared. RESULTS Overall, 45 patients underwent MIS, and 60 underwent RFA. Groups were not statistically different regarding type of underlying liver disease, HCC size, and AFP. However, RFA patients showed worse liver synthetic function with lower albumin and higher bilirubin serum levels, and higher ASA scores. Patients with HCC in segments 2-6 were more often treated by MIS. The incidence of complications was similar between groups (RFA: 6/60, 10 % vs. MIS: 5/45, 11 %, p = 0.854), and there was no measurable difference in the rate of procedure-related blood transfusions (RFA: 1/60, 1.7 % vs. MIS: 3/45, 6.7 %, p = 0.185). Local recurrence was only detected after RFA (11.7 %, p = 0.056, log-rank). Overall survival was higher in the MIS group (p = 0.042), with median survivals of 100 ± 13.5 versus 68 ± 15.9 months. CONCLUSION The present data need further validation. Selected patients with single ≤3-cm HCCs can be safely treated by MIS, without increased risk of perioperative complication, and with a lower risk of local recurrence. MIS should be especially favoured in patients with peripheral HCCs in segments 2-6, and/or when a histological assessment is desirable.
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Affiliation(s)
- Giulio C Vitali
- Divisions of Transplant and Abdominal Surgery, Department of Surgery, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
| | - Alexis Laurent
- Department of Hepato-Biliary Surgery and Liver Transplantation, Hôpital Henri Mondor, Créteil, France
| | - Sylvain Terraz
- Department of Radiology, University of Geneva Hospitals, Geneva, Switzerland.,Hepato-Pancreato-Biliary Centre, University of Geneva Hospitals, Geneva, Switzerland
| | - Pietro Majno
- Divisions of Transplant and Abdominal Surgery, Department of Surgery, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.,Hepato-Pancreato-Biliary Centre, University of Geneva Hospitals, Geneva, Switzerland
| | - Nicolas C Buchs
- Divisions of Transplant and Abdominal Surgery, Department of Surgery, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Laura Rubbia-Brandt
- Hepato-Pancreato-Biliary Centre, University of Geneva Hospitals, Geneva, Switzerland.,Division of Clinical Pathology, University of Geneva Hospitals, Geneva, Switzerland
| | - Alain Luciani
- Department of Radiology, Hôpital Henri Mondor, Créteil, France
| | | | - Philippe Morel
- Divisions of Transplant and Abdominal Surgery, Department of Surgery, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.,Hepato-Pancreato-Biliary Centre, University of Geneva Hospitals, Geneva, Switzerland
| | - Daniel Azoulay
- Department of Hepato-Biliary Surgery and Liver Transplantation, Hôpital Henri Mondor, Créteil, France
| | - Christian Toso
- Divisions of Transplant and Abdominal Surgery, Department of Surgery, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland. .,Hepato-Pancreato-Biliary Centre, University of Geneva Hospitals, Geneva, Switzerland.
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Robotic general surgery: current practice, evidence, and perspective. Langenbecks Arch Surg 2015; 400:283-92. [PMID: 25854502 DOI: 10.1007/s00423-015-1278-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 01/27/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Robotic technology commenced to be adopted for the field of general surgery in the 1990s. Since then, the da Vinci surgical system (Intuitive Surgical Inc, Sunnyvale, CA, USA) has remained by far the most commonly used system in this domain. The da Vinci surgical system is a master-slave machine that offers three-dimensional vision, articulated instruments with seven degrees of freedom, and additional software features such as motion scaling and tremor filtration. The specific design allows hand-eye alignment with intuitive control of the minimally invasive instruments. As such, robotic surgery appears technologically superior when compared with laparoscopy by overcoming some of the technical limitations that are imposed on the surgeon by the conventional approach. PURPOSE This article reviews the current literature and the perspective of robotic general surgery. CONCLUSIONS While robotics has been applied to a wide range of general surgery procedures, its precise role in this field remains a subject of further research. Until now, only limited clinical evidence that could establish the use of robotics as the gold standard for procedures of general surgery has been created. While surgical robotics is still in its infancy with multiple novel systems currently under development and clinical trials in progress, the opportunities for this technology appear endless, and robotics should have a lasting impact to the field of general surgery.
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