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Giuliani G, Matarazzo F, Guerra F, Roberto B, Marino MD, Coratti A. Ultrasound assessment of the distal resection margin during robotic rectal surgery. Colorectal Dis 2024. [PMID: 39073216 DOI: 10.1111/codi.17109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 07/06/2024] [Indexed: 07/30/2024]
Abstract
AIM Ensuring an adequate distal resection margin (DRM) is a key factor in achieving the gold standard in surgical treatment for rectal surgery. The aim of this article is to describe our surgical technique and the usefulness of intraoperative ultrasonography (IOUS) for evaluating the DRM during robotic rectal surgery (RRS). METHOD Prospective data on five consecutive patients with rectal cancer who underwent RRS between January 2023 and December 2023 were collected. IOUS was utilized to evaluate the DRM in all patients. RESULTS The mean time for the IOUS examination ranged from 5 to 10 min. There were no intraoperative complications or conversions to open surgery. The median length of hospital stay was 6.4 days (±1.67 days). During hospitalization, one patient experienced a Grade II complication according to the Clavien-Dindo classification, specifically postoperative ileus. Furthermore, one patient experienced a delayed anastomotic fistula, which was conservatively treated without readmission. At definitive pathology, the median distance of the tumour from the DRM was 29 mm (±1.41 mm) and all patients had an R0 resection. CONCLUSION IOUS is a reproducible and helpful modality for identifying the distal margin of the cutting line during robotic resection of rectal cancers. It does not affect the operating time compared with other methods and could be an alternative method for assessment of the DRM during RRS.
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Affiliation(s)
- Giuseppe Giuliani
- Department of General and Urgent Surgery, Misericordia Hospital, School of Robotic Surgery, USL Toscana Sud Est, Grosseto, Italy
| | - Francesco Matarazzo
- Department of General and Urgent Surgery, Misericordia Hospital, School of Robotic Surgery, USL Toscana Sud Est, Grosseto, Italy
| | - Francesco Guerra
- Department of General and Urgent Surgery, Misericordia Hospital, School of Robotic Surgery, USL Toscana Sud Est, Grosseto, Italy
| | - Benigni Roberto
- Department of General and Urgent Surgery, Misericordia Hospital, School of Robotic Surgery, USL Toscana Sud Est, Grosseto, Italy
| | - Michele Di Marino
- Department of General and Urgent Surgery, Misericordia Hospital, School of Robotic Surgery, USL Toscana Sud Est, Grosseto, Italy
| | - Andrea Coratti
- Department of General and Urgent Surgery, Misericordia Hospital, School of Robotic Surgery, USL Toscana Sud Est, Grosseto, Italy
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Pavone M, Baroni A, Taliento C, Goglia M, Lecointre L, Rosati A, Forgione A, Akladios C, Scambia G, Querleu D, Marescaux J, Seeliger B. Robotic platforms in gynaecological surgery: past, present, and future. Facts Views Vis Obgyn 2024; 16:163-172. [PMID: 38950530 DOI: 10.52054/fvvo.16.2.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024] Open
Abstract
Background More than two decades ago, the advent of robotic laparoscopic surgery marked a significant milestone, featuring the introduction of the AESOP robotic endoscope control system and the ZEUS robotic surgery system. The latter, equipped with distinct arms for the laparoscope and surgical instruments, was designed to accommodate remote connections, enabling the practice of remote telesurgery as early as 2001. Subsequent technological progress has given rise to a range of options in today's market, encompassing multi-port and single-port systems, both rigid and flexible, across various price points, with further growth anticipated. Objective This article serves as an indispensable guide for gynaecological surgeons with an interest in embracing robotic surgery. Materials and methods Drawing insights from the experience of the Strasbourg training centre for minimally invasive surgery (IRCAD), this article offers a comprehensive overview of existing robotic platforms in the market, as well as those in development. Results Robotic surgical systems not only streamline established operative methods but also broaden the scope of procedures, including intra- and transluminal surgeries. As integral components of the digital surgery ecosystem, these robotic systems actively contribute to the increasing integration and adoption of advanced technologies, such as artificial intelligence-based data analysis and support systems. Conclusion Robotic surgery is increasingly being adopted in clinical practice. With the growing number of systems available on the marketplace, the primary challenge lies in identifying the optimal platform for each specific procedure and patient. The seamless integration of robotic systems with artificial intelligence, image-guided surgery, and telesurgery presents undeniable advantages, enhancing the precision and effectiveness of surgical interventions. What is new? This article provides a guide to the robotic platforms available on the market and those in development for gynaecologists interested in robotic surgery.
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Pavone M, Baroni A, Campolo F, Goglia M, Raimondo D, Carcagnì A, Akladios C, Marescaux J, Fanfani F, Scambia G, Ianieri MM. Robotic assisted versus laparoscopic surgery for deep endometriosis: a meta-analysis of current evidence. J Robot Surg 2024; 18:212. [PMID: 38753180 PMCID: PMC11098866 DOI: 10.1007/s11701-024-01954-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/14/2024] [Indexed: 05/19/2024]
Abstract
Endometriosis is a benign inflammatory onco-mimetic disease affecting 10-15% of women in the world. When it is refractory to medical treatments, surgery may be required. Usually, laparoscopy is the preferred approach, but robotic surgery has gained popularity in the last 15 years. This study aims to evaluate the safety and efficacy of robotic-assisted laparoscopic surgery (RAS) versus conventional laparoscopic surgery (LPS) in the treatment of endometriosis. This study adheres to PRISMA guidelines and is registered with PROSPERO. Studies reporting perioperative data comparing RAS and LPS surgery in patients with endometriosis querying PubMed, Google Scholar and ClinicalTrials.gov were included in the analysis. The Quality Assessment of Diagnostic Accuracy Studies 2 tool (QUADAS-2) was used for the quality assessment of the selected articles. Fourteen studies were identified, including 2709 patients with endometriosis stage I-IV for the meta-analysis. There were no significant differences between RAS and LPS in terms of intraoperative and postoperative complications, conversion rate and estimated blood loss. However, patients in the RAS group have a longer operative time (p < 0.0001) and longer hospital stay (p = 0.020) than those in the laparoscopic group. Robotic surgery is not inferior to laparoscopy in patients with endometriosis in terms of surgical outcomes; however, RAS requires longer operative times and longer hospital stay. The benefits of robotic surgery should be sought in the easiest potential integration of robotic platforms with new technologies. Prospective studies comparing laparoscopy to the new robotic systems are desirable for greater robustness of scientific evidence.
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Affiliation(s)
- Matteo Pavone
- UOC Ginecologia Oncologica, Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France.
- Research Institute against Digestive Cancer, IRCAD, Strasbourg, France.
| | - Alessandro Baroni
- UOC Ginecologia Oncologica, Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Federica Campolo
- UOC Ginecologia Oncologica, Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Marta Goglia
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Diego Raimondo
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonella Carcagnì
- Facility of Epidemiology and Biostatistics - Gemelli Generator, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Cherif Akladios
- Department of Gynecologic Surgery, University Hospitals of Strasbourg, Strasbourg, France
| | - Jacques Marescaux
- Research Institute against Digestive Cancer, IRCAD, Strasbourg, France
| | - Francesco Fanfani
- UOC Ginecologia Oncologica, Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Manuel Maria Ianieri
- UOC Ginecologia Oncologica, Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
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Pavone M, Seeliger B, Teodorico E, Goglia M, Taliento C, Bizzarri N, Lecointre L, Akladios C, Forgione A, Scambia G, Marescaux J, Testa AC, Querleu D. Ultrasound-guided robotic surgical procedures: a systematic review. Surg Endosc 2024; 38:2359-2370. [PMID: 38512350 PMCID: PMC11078854 DOI: 10.1007/s00464-024-10772-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/24/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Ultrasound has been nicknamed "the surgeon's stethoscope". The advantages of laparoscopic ultrasound beyond a substitute for the sense of touch are considerable, especially for robotic surgery. Being able to see through parenchyma and into vascular structures enables to avoid unnecessary dissection by providing a thorough assessment at every stage without the need for contrast media or ionising radiation. The limitations of restricted angulation and access within the abdominal cavity during laparoscopy can be overcome by robotic handling of miniaturised ultrasound probes and the use of various and specific frequencies will meet tissue- and organ-specific characteristics. The aim of this systematic review was to assess the reported applications of intraoperative ultrasound-guided robotic surgery and to outline future perspectives. METHODS The study adhered to the PRISMA guidelines. PubMed, Google Scholar, ScienceDirect and ClinicalTrials.gov were searched up to October 2023. Manuscripts reporting data on ultrasound-guided robotic procedures were included in the qualitative analysis. RESULTS 20 studies met the inclusion criteria. The majority (53%) were related to the field of general surgery during liver, pancreas, spleen, gallbladder/bile duct, vascular and rectal surgery. This was followed by other fields of oncological surgery (42%) including urology, lung surgery, and retroperitoneal lymphadenectomy for metastases. Among the studies, ten (53%) focused on locating tumoral lesions and defining resection margins, four (15%) were designed to test the feasibility of robotic ultrasound-guided surgery, while two (10.5%) aimed to compare robotic and laparoscopic ultrasound probes. Additionally two studies (10.5%) evaluated the robotic drop-in probe one (5%) assessed the hepatic tissue consistency and another one (5%) aimed to visualize the blood flow in the splenic artery. CONCLUSION The advantages of robotic instrumentation, including ergonomics, dexterity, and precision of movements, are of relevance for robotic intraoperative ultrasound (RIOUS). The present systematic review demonstrates the virtue of RIOUS to support surgeons and potentially reduce minimally invasive procedure times.
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Affiliation(s)
- Matteo Pavone
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France.
- Research Institute Against Digestive Cancer, IRCAD, Strasbourg, France.
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
| | - Barbara Seeliger
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
- Research Institute Against Digestive Cancer, IRCAD, Strasbourg, France
- Department of Digestive and Endocrine Surgery, University Hospitals of Strasbourg, Strasbourg, France
- ICube, UMR 7357 CNRS, University of Strasbourg, Strasbourg, France
| | - Elena Teodorico
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Marta Goglia
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Cristina Taliento
- Department of Obstetrics and Gynecology, University Hospital Ferrara, Ferrara, Italy
- Department of Obstetrics and Gynecology, University Hospitals Leuven, 3000, Leuven, Belgium
| | - Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Lise Lecointre
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
- ICube, UMR 7357 CNRS, University of Strasbourg, Strasbourg, France
- Department of Gynecologic Surgery, University Hospitals of Strasbourg, Strasbourg, France
| | - Cherif Akladios
- Department of Gynecologic Surgery, University Hospitals of Strasbourg, Strasbourg, France
| | | | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Jacques Marescaux
- Research Institute Against Digestive Cancer, IRCAD, Strasbourg, France
| | - Antonia C Testa
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Denis Querleu
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
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Goodsell KE, Park JO. Robotic hepatectomy: current evidence and future directions. Minerva Surg 2023; 78:525-536. [PMID: 36946128 DOI: 10.23736/s2724-5691.23.09858-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Minimally invasive hepatectomy continues to gain popularity and acceptance for treatment of benign and malignant liver disease. Robotic hepatectomy offers potential advantages over open and conventional laparoscopic approaches. Review of the literature on robotic hepatectomy was performed. Search terms included "robotic hepatectomy" and "minimally invasive hepatectomy." Search was further customized to include articles related to robotic surgical technology. Across many parameters in liver surgery, robotic liver resection appears to have comparable outcomes with respect to laparoscopic resection. The benefits over open resection are largely related to less morbidity and faster recovery times. There is evidence that the robotic approach may have a shorter learning curve and enable more difficult resections to be performed minimally invasively. The robotic platform may have the potential to achieve superior margin status or parenchymal sparing resection in oncologic resections, but numerous obstacles remain. The robotic platform has not been applied to liver surgery to the same extent as either laparoscopic or open surgery. Robotic surgical technology will need to continue developing to deliver on its potential advantages.
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Affiliation(s)
| | - James O Park
- Department of Surgery, University of Washington, Seattle, WA, USA
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6
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Rompianesi G, Pegoraro F, Ramaci L, Ceresa CD, Montalti R, Troisi RI. Preoperative planning and intraoperative real-time navigation with indocyanine green fluorescence in robotic liver surgery. Langenbecks Arch Surg 2023; 408:292. [PMID: 37522938 PMCID: PMC10390613 DOI: 10.1007/s00423-023-03024-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/20/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE We aimed at exploring indocyanine green (ICG) fluorescence wide spectrum of applications in hepatobiliary surgery as can result particularly useful in robotic liver resections (RLR) in order to overcome some technical limitations, increasing safety, and efficacy. METHODS We describe our experience of 76 RLR performed between March 2020 and December 2022 exploring all the possible applications of pre- and intraoperative ICG administration. RESULTS Hepatocellular carcinoma and colorectal liver metastases were the most common indications for RLR (34.2% and 26.7% of patients, respectively), and 51.3% of cases were complex resections with high IWATE difficulty scores. ICG was administered preoperatively in 61 patients (80.3%), intraoperatively in 42 patients (55.3%) and in both contexts in 25 patients (32.9%), with no observed adverse events. The most frequent ICG goal was to achieve tumor enhancement (59 patients, 77.6%), with a success rate of 94.9% and the detection of 3 additional malignant lesions. ICG facilitated evaluation of the resection margin for residual tumor and perfusion adequacy in 33.9% and 32.9% of cases, respectively, mandating a resection enlargement in 7.9% of patients. ICG fluorescence allowed the identification of the transection plane through negative staining in the 25% of cases. Vascular and biliary structures were visualized in 21.1% and 9.2% of patients, with a success rate of 81.3% and 85.7%, respectively. CONCLUSION RLR can benefit from the routine integration of ICG fluoresce evaluation according to each individual patient and condition-specific goals and issues, allowing liver functional assessment, anatomical and vascular evaluation, tumor detection, and resection margins assessment.
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Affiliation(s)
- Gianluca Rompianesi
- Division of Hepato-Biliary-Pancreatic, Minimally Invasive and Robotic Surgery and Kidney Transplantation, Department of Clinical Medicine and Surgery, Federico II University Hospital, via S. Pansini n. 5, Naples, Italy.
| | - Francesca Pegoraro
- Division of Hepato-Biliary-Pancreatic, Minimally Invasive and Robotic Surgery and Kidney Transplantation, Department of Clinical Medicine and Surgery, Federico II University Hospital, via S. Pansini n. 5, Naples, Italy
| | - Lorenzo Ramaci
- Division of Hepato-Biliary-Pancreatic, Minimally Invasive and Robotic Surgery and Kidney Transplantation, Department of Clinical Medicine and Surgery, Federico II University Hospital, via S. Pansini n. 5, Naples, Italy
| | - Carlo Dl Ceresa
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Roberto Montalti
- Division of Hepato-Biliary-Pancreatic, Minimally Invasive and Robotic Surgery and Kidney Transplantation, Department of Public Health Federico II University Hospital, Naples, Italy
| | - Roberto I Troisi
- Division of Hepato-Biliary-Pancreatic, Minimally Invasive and Robotic Surgery and Kidney Transplantation, Department of Clinical Medicine and Surgery, Federico II University Hospital, via S. Pansini n. 5, Naples, Italy
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Rahimli M, Perrakis A, Andric M, Stockheim J, Franz M, Arend J, Al-Madhi S, Abu Hilal M, Gumbs AA, Croner RS. Does Robotic Liver Surgery Enhance R0 Results in Liver Malignancies during Minimally Invasive Liver Surgery?—A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14143360. [PMID: 35884421 PMCID: PMC9320889 DOI: 10.3390/cancers14143360] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 12/22/2022] Open
Abstract
Background: Robotic procedures are an integral part of modern liver surgery. However, the advantages of a robotic approach in comparison to the conventional laparoscopic approach are the subject of controversial debate. The aim of this systematic review and meta-analysis is to compare robotic and laparoscopic liver resection with particular attention to the resection margin status in malignant cases. Methods: A systematic literature search was performed using PubMed and Cochrane Library in accordance with the PRISMA guidelines. Only studies comparing robotic and laparoscopic liver resections were considered for this meta-analysis. Furthermore, the rate of the positive resection margin or R0 rate in malignant cases had to be clearly identifiable. We used fixed or random effects models according to heterogeneity. Results: Fourteen studies with a total number of 1530 cases were included in qualitative and quantitative synthesis. Malignancies were identified in 71.1% (n = 1088) of these cases. These included hepatocellular carcinoma, cholangiocarcinoma, colorectal liver metastases and other malignancies of the liver. Positive resection margins were noted in 24 cases (5.3%) in the robotic group and in 54 cases (8.6%) in the laparoscopic group (OR = 0.71; 95% CI (0.42–1.18); p = 0.18). Tumor size was significantly larger in the robotic group (MD = 6.92; 95% CI (2.93–10.91); p = 0.0007). The operation time was significantly longer in the robotic procedure (MD = 28.12; 95% CI (3.66–52.57); p = 0.02). There were no significant differences between the robotic and laparoscopic approaches regarding the intra-operative blood loss, length of hospital stay, overall and severe complications and conversion rate. Conclusion: Our meta-analysis showed no significant difference between the robotic and laparoscopic procedures regarding the resection margin status. Tumor size was significantly larger in the robotic group. However, randomized controlled trials with long-term follow-up are needed to demonstrate the benefits of robotics in liver surgery.
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Affiliation(s)
- Mirhasan Rahimli
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany; (A.P.); (M.A.); (J.S.); (M.F.); (J.A.); (S.A.-M.); (R.S.C.)
- Correspondence:
| | - Aristotelis Perrakis
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany; (A.P.); (M.A.); (J.S.); (M.F.); (J.A.); (S.A.-M.); (R.S.C.)
| | - Mihailo Andric
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany; (A.P.); (M.A.); (J.S.); (M.F.); (J.A.); (S.A.-M.); (R.S.C.)
| | - Jessica Stockheim
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany; (A.P.); (M.A.); (J.S.); (M.F.); (J.A.); (S.A.-M.); (R.S.C.)
| | - Mareike Franz
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany; (A.P.); (M.A.); (J.S.); (M.F.); (J.A.); (S.A.-M.); (R.S.C.)
| | - Joerg Arend
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany; (A.P.); (M.A.); (J.S.); (M.F.); (J.A.); (S.A.-M.); (R.S.C.)
| | - Sara Al-Madhi
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany; (A.P.); (M.A.); (J.S.); (M.F.); (J.A.); (S.A.-M.); (R.S.C.)
| | - Mohammed Abu Hilal
- Unità Chirurgia Epatobiliopancreatica, Robotica e Mininvasiva, Fondazione Poliambulanza Istituto Ospedaliero, Via Bissolati, 57, 25124 Brescia, Italy;
| | - Andrew A. Gumbs
- Department of Surgery, Centre Hospitalier Intercommunal de Poissy/Saint-Germain-en-Laye, 10 Rue du Champ Gaillard, 78300 Poissy, France;
| | - Roland S. Croner
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany; (A.P.); (M.A.); (J.S.); (M.F.); (J.A.); (S.A.-M.); (R.S.C.)
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8
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Pesi B, Bencini L, Moraldi L, Tofani F, Batignani G, Bechi P, Farsi M, Annecchiarico M, Coratti A. Robotic Versus Open Liver Resection in Hepatocarcinoma: Surgical and Oncological Outcomes. Surg Laparosc Endosc Percutan Tech 2021; 31:468-474. [PMID: 33480668 DOI: 10.1097/sle.0000000000000904] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 11/19/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Minimally invasive approaches are spreading in every field of surgery, including liver surgery. However, studies comparing robotic hepatectomy with the conventional open approach regarding oncologic outcomes for hepatocellular carcinoma are limited. MATERIALS AND METHODS We retrospectively reviewed demographics characteristics, pathologic features, surgical, and oncological outcomes of patients who underwent robotic and conventional open liver resection for hepatocellular carcinoma. RESULTS No significant differences in demographics features, tumor size, tumor location, and type of liver resection were found. The morbidity rate was similar, 23% for the open group versus 17% of the robotic group (P=0.605). Perioperative data analysis showed a greater estimated blood loss in patients who underwent open resection, if compared with robotic group (P=0.003). R0 resection and disease-free resection margins showed no statistically significant differences. The 3-year disease-free survival of the robotic group was comparable with that of the open group (54% vs. 37%; P=0.592), as was the 3-year overall survival (87% vs. 78%; P=0.203). CONCLUSIONS The surgical and the oncological outcomes seem to be comparable between minimally invasive and open hepatectomy. Robotic liver resections are effective, and do not compromise the oncological outcome, representing a reasonable alternative to the open approach.
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Affiliation(s)
- Benedetta Pesi
- Division of Oncological and Robotic General Surgery, Careggi University Hospital
| | - Lapo Bencini
- Division of Oncological and Robotic General Surgery, Careggi University Hospital
| | - Luca Moraldi
- Division of Oncological and Robotic General Surgery, Careggi University Hospital
| | - Federica Tofani
- Division of Oncological and Robotic General Surgery, Careggi University Hospital
| | - Giacomo Batignani
- Department of Surgery and Translational Medicine, Hepatobiliary Surgery Unit, University of Florence, Florence, Italy
| | - Paolo Bechi
- Department of Surgery and Translational Medicine, Hepatobiliary Surgery Unit, University of Florence, Florence, Italy
| | - Marco Farsi
- Division of Oncological and Robotic General Surgery, Careggi University Hospital
| | - Mario Annecchiarico
- Division of Oncological and Robotic General Surgery, Careggi University Hospital
| | - Andrea Coratti
- Division of Oncological and Robotic General Surgery, Careggi University Hospital
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9
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Ciria R, Berardi G, Alconchel F, Briceño J, Choi GH, Wu YM, Sugioka A, Troisi RI, Salloum C, Soubrane O, Pratschke J, Martinie J, Tsung A, Araujo R, Sucandy I, Tang CN, Wakabayashi G. The impact of robotics in liver surgery: A worldwide systematic review and short-term outcomes meta-analysis on 2,728 cases. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 29:181-197. [PMID: 33200536 DOI: 10.1002/jhbp.869] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 10/22/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The dissemination of robotic liver surgery is slow-paced and must face the obstacle of demonstrating advantages over open and laparoscopic (LLS) approaches. Our objective was to show the current position of robotic liver surgery (RLS) worldwide and to identify if improved short-term outcomes are observed, including secondary meta-analyses for type of resection, etiology, and cost analysis. METHODS A PRISMA-based systematic review was performed to identify manuscripts comparing RLS vs open or LLS approaches. Quality analysis was performed using the Newcatle-Ottawa score. Statistical analysis was performed after heterogeneity test and fixed- or random-effect models were chosen accordingly. RESULTS After removing duplications, 2728 RLS cases were identified from the final set of 150 manuscripts. More than 75% of the cases have been performed on malignancies. Meta-analysis from the 38 comparative reports showed that RLS may offer improved short-term outcomes compared to open procedures in most of the variables screened. Compared to LLS, some advantages may be observed in favour of RLS for major resections in terms of operative time, hospital stay and rate of complications. Cost analyses showed an increased cost per procedure of around US$5000. CONCLUSIONS The advantages of RLS still need to be demonstrated although early results are promising. Advantages vs open approach are demonstrated. Compared to laparoscopic surgery, minor perioperative advantages may be observed for major resections although cost analyses are still unfavorable to the robotic approach.
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Affiliation(s)
- Ruben Ciria
- Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, Córdoba, Spain
| | - Giammauro Berardi
- Center for Advanced Treatment of HBP Diseases, Ageo Central General Hospital, Saitama, Japan.,Department of Human Structure and Repair of Man, Ghent University, Ghent, Belgium
| | - Felipe Alconchel
- Unit of Hepatobiliary Surgery and Liver Transplantation, Virgen de la Arrixaca University Hospital (IMIB-Arrixaca), Murcia, Spain
| | - Javier Briceño
- Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, Córdoba, Spain
| | - Gi Hong Choi
- Division of Hepatopancreaticobiliary Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Yao-Ming Wu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Atsushi Sugioka
- Department of Surgery, Fujita Health University, Toyoake, Japan
| | - Roberto Ivan Troisi
- Department of Human Structure and Repair of Man, Ghent University, Ghent, Belgium.,Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.,Department of HPB Surgery and Liver Transplantation, King Faisal Hospital and Research Center, Al Faisal University, Riyadh, Saudi Arabia
| | - Chady Salloum
- Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est, Créteil, France.,Centre Hépato-Biliaire, Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris, Université Paris-Sud, Villejuif, France
| | - Olivier Soubrane
- Department of Hepatobiliary and Liver Transplantation Surgery, Hôpital Beaujon, Paris, France
| | - Johann Pratschke
- Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - John Martinie
- Division of HPB Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Allan Tsung
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Raphael Araujo
- Barretos Cancer Hospital, São Paulo, Brazil.,Escola Paulista de Medicina-UNIFESP, São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Iswanto Sucandy
- Digestive Disease Institute, Florida Hospital Tampa, Tampa, FL, USA
| | - Chung N Tang
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - Go Wakabayashi
- Center for Advanced Treatment of HBP Diseases, Ageo Central General Hospital, Saitama, Japan
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10
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Di Maria Grimaldi S, Marano A, Pellegrino L, Geretto P, Palagi S, Borghi F. Robotic Wedge Resection for Unfavorably Located Gastric Gastrointestinal Stromal Tumors: Perioperative and Long-Term Oncological Outcomes. J Laparoendosc Adv Surg Tech A 2020; 31:772-778. [PMID: 33155875 DOI: 10.1089/lap.2020.0660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Background and Objectives: Robotic wedge resection for gastrointestinal stromal tumors (GISTs) located in the stomach offers remarkable advantages, especially for lesions in unfavorable places. Although promising, long-term oncological results associated with this surgical procedure are poorly represented in literature. We present our experience of robotic wedge resection with gastrotomy for challenging gastric GISTs, in terms of both surgical outcomes and long-term oncological results. Methods: From April 2014 to February 2020, all consecutive patients affected by unfavorably located gastric GISTs (based on the Privette/Al-Thani classification system) underwent robotic wedge resection. Clinicopathological, surgical, and long-term oncological results were retrospectively analyzed. Results: Seventeen patients underwent full-thickness gastric wedge resection with primary robot-sewn closure of the defect. In 64.7% of cases, the lesion was ≥5 cm in diameter. No conversion nor tumor rupture were recorded and complete R0 resection was achieved in all cases. Median hospital stay was 5 days (range 3-18). At a median follow-up of 46 months (range 7-67), the disease-free survival rate and the overall survival rate were 94.1% and 82.3%, respectively. Conclusions: Robotic wedge resection with gastrotomy and robotic-sewn suture is a safe and feasible procedure for GISTs located in unfavorable anatomic positions, without compromising oncological outcomes.
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Affiliation(s)
- Simone Di Maria Grimaldi
- General and Oncologic Surgery Unit, Department of Surgery, ASO Santa Croce e Carle, Cuneo, Italy
| | - Alessandra Marano
- General and Oncologic Surgery Unit, Department of Surgery, ASO Santa Croce e Carle, Cuneo, Italy
| | - Luca Pellegrino
- General and Oncologic Surgery Unit, Department of Surgery, ASO Santa Croce e Carle, Cuneo, Italy
| | - Paolo Geretto
- General and Oncologic Surgery Unit, Department of Surgery, ASO Santa Croce e Carle, Cuneo, Italy
| | - Silvia Palagi
- General and Oncologic Surgery Unit, Department of Surgery, ASO Santa Croce e Carle, Cuneo, Italy
| | - Felice Borghi
- General and Oncologic Surgery Unit, Department of Surgery, ASO Santa Croce e Carle, Cuneo, Italy
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11
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Keating MF, Zhang J, Feider CL, Retailleau S, Reid R, Antaris A, Hart B, Tan G, Milner TE, Miller K, Eberlin LS. Integrating the MasSpec Pen to the da Vinci Surgical System for In Vivo Tissue Analysis during a Robotic Assisted Porcine Surgery. Anal Chem 2020; 92:11535-11542. [PMID: 32786489 DOI: 10.1021/acs.analchem.0c02037] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Minimally invasive robotic-assisted surgeries have been increasingly used as a first-line of treatment for patients undergoing oncologic surgeries. In-situ tissue identification is critical to guide tissue resection and assist decision-making. Traditional intraoperative histopathologic analysis of frozen tissue sections can be time-consuming and present logistical challenges which interrupt surgical workflows. We report the development and implementation of a laparoscopic, drop-in version of the MasSpec Pen device integrated into the da Vinci Xi Surgical system for in vivo tissue analysis in a robotic-assisted porcine surgery. We evaluated the performance of the drop-in MasSpec Pen during surgery by introducing the device into the animal upper gastrointestinal system and performing in vivo analyses of the stomach and liver, including charred and bloody tissues after electrocauterization. The molecular profiles obtained included ions tentatively identified as metabolites and lipids typically observed with MasSpec Pen analysis, without causing observable tissue damage. Statistical classifiers built to distinguish porcine liver and stomach tissues using the in vivo data yielded an overall tissue identification accuracy of 98% (n = 53 analyses). The results provide evidence that the drop-in MasSpec Pen developed can be used to acquire mass spectra in vivo during a robotic-assisted surgery and might be used as an in vivo tissue assessment tool to help guide surgical resections and streamline surgical workflows.
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Affiliation(s)
- Michael F Keating
- Department of Chemistry, The University of Texas at Austin, Austin, Texas 78751, United States
| | - Jialing Zhang
- Department of Chemistry, The University of Texas at Austin, Austin, Texas 78751, United States
| | - Clara L Feider
- Department of Chemistry, The University of Texas at Austin, Austin, Texas 78751, United States
| | | | - Robert Reid
- Intuitive Surgical, Sunnyvale, California 94086, United States
| | | | - Bradley Hart
- Thermo Fisher Scientific, San Jose, California 95134, United States
| | - Gina Tan
- Thermo Fisher Scientific, San Jose, California 95134, United States
| | - Thomas E Milner
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas 78751, United States
| | - Kyle Miller
- Intuitive Surgical, Sunnyvale, California 94086, United States
| | - Livia S Eberlin
- Department of Chemistry, The University of Texas at Austin, Austin, Texas 78751, United States
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12
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Kose E, Karahan SN, Berber E. Robotic Liver Resection: Recent Developments. CURRENT SURGERY REPORTS 2020. [DOI: 10.1007/s40137-020-00254-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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13
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Hagopian EJ. Liver ultrasound: A key procedure in the surgeon's toolbox. J Surg Oncol 2020; 122:61-69. [DOI: 10.1002/jso.25908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Ellen J. Hagopian
- Department of General SurgeryHackensack‐Meridian School of Medicine at Seton Hall University New Jersey
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14
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Navarro J, Rho SY, Kang I, Choi GH, Min BS. Robotic simultaneous resection for colorectal liver metastasis: feasibility for all types of liver resection. Langenbecks Arch Surg 2019; 404:895-908. [PMID: 31797029 DOI: 10.1007/s00423-019-01833-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 10/21/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND A laparoscopic approach is increasingly being utilized in simultaneous colorectal and liver resection (SCLR) for colorectal cancer with liver metastasis. However, this approach is technically challenging and hence has not been widely adopted. Robotic surgical systems could potentially overcome this problem. We aim to describe the feasibility and outcomes of robotic SCLR for colorectal carcinoma with liver metastasis. METHODS The medical records of 12 patients who underwent robotic SCLR for colorectal cancer with liver metastasis between January 2008 and September 2018 were reviewed retrospectively. RESULTS The mean age was 59 years (range, 37-77 years). The liver resections were comprised of two right hepatectomies, one left hepatectomy, one left lateral sectionectomy, one segmentectomy of S3 and wedge resection (segment 7), one caudate lobectomy, one associated liver partition and portal vein ligation for staged hepatectomy, and five wedge resections involving segments 4, 5, 6, 7, or 8. The colorectal procedures involved seven low-anterior resections, two anterior resections, two right hemicolectomies, and one left hemicolectomy. The mean operative time was 449 min (range, 135-682 min) with a mean estimated blood loss of 274.3 mL (range, 40-780 mL). The mean length of hospital stay was 12 days (range, 5-28 days). No patients required conversion to laparotomy. Liver resection-related complications were two liver abscesses (Clavien-Dindo classification, one grade II and one grade III) and one case of ascites (grade I), whereas colorectal resection-related complications included one anastomosis leak (grade III) and one superficial wound infection (grade II). There were no deaths reported within 30 days of the procedure. With a mean follow-up duration of 31.5 ± 26.1 months, the overall survival and disease-free survival values were 75.2 and 47.1 months, respectively. CONCLUSION Robotic SCLR for colorectal neoplasm with liver metastasis can be performed safely even in cases requiring major liver resections, especially in a specialized center with a well-trained team.
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Affiliation(s)
- Jonathan Navarro
- Department of Surgery, Yonsei University College of Medicine, #50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.,Department of Surgery, Vicente Sotto MemorialMedical Center, B. Rodriguez street, Cebu City, 6000, Philippines
| | - Seoung Yoon Rho
- Department of Surgery, Yonsei University College of Medicine, #50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Incheon Kang
- Department of Surgery, Yonsei University College of Medicine, #50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Gi Hong Choi
- Department of Surgery, Yonsei University College of Medicine, #50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
| | - Byung Soh Min
- Department of Surgery, Yonsei University College of Medicine, #50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
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15
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Morelli L, Furbetta N, Gianardi D, Palmeri M, Di Franco G, Bianchini M, Stefanini G, Guadagni S, Di Candio G. Robot-assisted trans-gastric drainage and debridement of walled-off pancreatic necrosis using the EndoWrist stapler for the da Vinci Xi: A case report. World J Clin Cases 2019; 7:1461-1466. [PMID: 31363474 PMCID: PMC6656665 DOI: 10.12998/wjcc.v7.i12.1461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/24/2019] [Accepted: 05/02/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Walled-off pancreatic necrosis (WOPN) is a late complication of acute pancreatitis. The management of a WOPN depends on its location and on patient's symptoms. Trans-gastric drainage and debridement of WOPN represents an important surgical treatment option for selected patients. The da Vinci surgical System has been developed to allow an easy, minimally invasive and fast surgery, also in challenging abdominal procedures. We present here a case of a WOPN treated with a robotic trans-gastric drainage using the da Vinci Xi.
CASE SUMMARY A 63-year-old man with an episode of acute necrotizing pancreatitis was referred to our center. Six wk after the acute episode the patient developed a walled massive fluid collection, with an extensive pancreatic necrosis, causing obstruction of the gastrointestinal tract. The patient underwent a robotic trans-gastric drainage and debridement of the WOPN performed with the da Vinci Xi platform. Firstly, an anterior ideal gastrotomy was carried out, guided by intraoperative ultrasound (US)-scan using the TilePro™ function. Then, through the gastrotomy, the best location for drainage on the posterior gastric wall was again US-guided identified. The anastomosis between the posterior gastric wall and the walled-off necrosis wall was carried out with the new EndoWrist stapler with vascular cartridge. Debridement and washing of the cavity through the anastomosis were performed. Finally, the anterior gastrotomy was closed and the cholecystectomy was performed. The postoperative course was uneventful and a post-operative computed tomography-scan showed the collapse of the fluid collection.
CONCLUSION In selected cases of WOPN the da Vinci Surgical System can be safely used as a valid surgical treatment option.
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Affiliation(s)
- Luca Morelli
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56124, Italy
- EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa 56124, Italy
| | - Niccolò Furbetta
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56124, Italy
| | - Desirée Gianardi
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56124, Italy
| | - Matteo Palmeri
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56124, Italy
| | - Gregorio Di Franco
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56124, Italy
| | - Matteo Bianchini
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56124, Italy
| | - Gianni Stefanini
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56124, Italy
| | - Simone Guadagni
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56124, Italy
| | - Giulio Di Candio
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56124, Italy
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16
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Magistri P, Pecchi A, Franceschini E, Pesi B, Guadagni S, Catellani B, Assirati G, Guidetti C, Guerrini GP, Tarantino G, Ballarin R, Codeluppi M, Morelli L, Coratti A, Di Benedetto F. Not just minor resections: robotic approach for cystic echinococcosis of the liver. Infection 2019; 47:973-979. [PMID: 31236898 DOI: 10.1007/s15010-019-01333-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/06/2019] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Human echinococcosis is among the 17 neglected tropical diseases recognized by the World Health Organization. It is responsible for over $3 billion of health costs every year being endemic in large areas worldwide, and liver is affected in 70% of the cases. Surgery associated to medical treatment is the gold standard and robotic approach may be a valuable tool to achieve safe, parenchyma sparing resections. METHODS We retrospectively analyzed the outcomes of patients that underwent robotic radical surgical treatment for hydatid liver disease, from prospectively maintained databases of three Italian centers. RESULTS 15 patients were included in this study, median age 51 years (24-76). 1 right hepatectomy, 2 left lateral sectionectomies, 5 segmentectomies (including 1 caudatectomy), 3 wedge resections and 5 cyst-pericystectomies were performed. Median estimated blood loss was of 100 ml (50-550 ml), and median operative time including docking was 210 min (95-590 min), with no need for conversion to open. Median hospital stay was 4 days, with only one readmission for fever. Only one patient experienced recurrence in a different liver segment. CONCLUSIONS In our experience, robotic approach for cystic echinococcosis of the liver proved to be a safe and effective strategy also in the so-called "difficult segments", with short post-operative stay and quick return to daily activities, along with the absence of surgical site recurrences. To the best of our knowledge, this is the largest report of robotic approach to hydatid liver disease.
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Affiliation(s)
- Paolo Magistri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, MO, Italy
| | - Annarita Pecchi
- Department of Radiology, "Policlinico" University Hospital of Modena, 41124, Modena, MO, Italy
| | - Erica Franceschini
- Department of Infectious Diseases, "Policlinico" University Hospital of Modena, 41124, Modena, MO, Italy
| | - Benedetta Pesi
- Division of Oncologic Surgery and Robotics, Azienda Ospedaliero-Universitaria Di Careggi, 50139, Florence, FI, Italy
| | - Simone Guadagni
- Department of Translational and New Technologies in Medicine and Surgery, University of Pisa, 56124, Pisa, Italy
| | - Barbara Catellani
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, MO, Italy
| | - Giacomo Assirati
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, MO, Italy
| | - Cristiano Guidetti
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, MO, Italy
| | - Gian Piero Guerrini
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, MO, Italy
| | - Giuseppe Tarantino
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, MO, Italy
| | - Roberto Ballarin
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, MO, Italy
| | - Mauro Codeluppi
- Department of Infectious Diseases, "Policlinico" University Hospital of Modena, 41124, Modena, MO, Italy
| | - Luca Morelli
- Department of Translational and New Technologies in Medicine and Surgery, University of Pisa, 56124, Pisa, Italy
| | - Andrea Coratti
- Division of Oncologic Surgery and Robotics, Azienda Ospedaliero-Universitaria Di Careggi, 50139, Florence, FI, Italy
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, MO, Italy.
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17
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Pesi B, Moraldi L, Guerra F, Tofani F, Nerini A, Annecchiarico M, Coratti A. Surgical and oncological outcomes after ultrasound-guided robotic liver resections for malignant tumor. Analysis of a prospective database. Int J Med Robot 2019; 15:e2002. [PMID: 31022774 DOI: 10.1002/rcs.2002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 03/29/2019] [Accepted: 04/15/2019] [Indexed: 12/23/2022]
Abstract
AIM Robotic surgery is thought to have a role in widening the application of minimally invasive liver surgery. Nonetheless, data concerning surgical results for liver malignancies are presently still lacking. We aimed to evaluate the surgical and oncological outcomes of ultrasound guided robotic liver resections for hepatic malignancies. METHODS All consecutive patients who received robotic resection of primary and secondary liver malignancies from September 2008 to January 2017 were analyzed. The same surgical team performed all procedures following the principle of parenchymal-sparing surgery. RESULTS From a total of 51 patients, 13 patients (25%) underwent major and 38 (75%) minor hepatectomy. No mortality occurred. Two procedures were converted to open surgery. Five patients experienced major complications, with a reintervention rate of 6%. Median hospital stay was 5 days. CONCLUSIONS Robotic surgery is a safe and feasible procedure for liver resection even when dealing with malignancies. Our data show that robotic surgery can be considered a valid option to treat patients with liver malignancies in a minimally invasive manner, without compromise the oncological results.
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Affiliation(s)
- Benedetta Pesi
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Luca Moraldi
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Francesco Guerra
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Federica Tofani
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Alessandro Nerini
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Mario Annecchiarico
- 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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18
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Improving Outcomes Defending Patient Safety: The Learning Journey in Robotic Liver Resections. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1835085. [PMID: 31080809 PMCID: PMC6476155 DOI: 10.1155/2019/1835085] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 03/25/2019] [Indexed: 12/12/2022]
Abstract
Background While laparoscopy is currently adopted for hepatic resections, robotic approaches to the liver have not gained wide acceptance. We decided to analyze the learning curve in the field of robotic liver surgery comparing short-term outcomes between the first and the second half of our series. Methods We retrospectively reviewed demographics and clinical data of patients who underwent robotic liver resection at our institution from July 2014 through September 2017. 60 patients diagnosed with primary or secondary liver neoplasms or hydatid disease were included in this study. ASA PS >3, heart failure, respiratory insufficiency, and general contraindication to pneumoperitoneum were exclusion criteria. Results 60 patients were included. We observed a statistically significant decrease in operative time (p<0.001), intraoperative blood loss (p=0.01), and postoperative complications (p<0.001) after 30 cases. From the interpretation of the CUSUM curve, the time of operation appears to be significantly reduced after the first 30 operations. Discussion This is the first European analysis of the learning curve for robotic liver resection in an HPB and liver transplant referral center. However, more studies are needed to confirm such results outside a HPB referral center. This is crucial to develop formal credentialing protocols for both junior and senior surgeons.
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19
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Fahrner R, Rauchfuß F, Bauschke A, Kissler H, Settmacher U, Zanow J. Robotic hepatic surgery in malignancy: review of the current literature. J Robot Surg 2019; 13:533-538. [PMID: 30895519 DOI: 10.1007/s11701-019-00939-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 02/25/2019] [Indexed: 12/18/2022]
Abstract
The use of minimally invasive liver surgery, such as laparoscopic and robotic surgery, is increasing worldwide. Robot-assisted laparoscopy is a new surgical technique that improves surgical handling. The advantage of this technique is improved dexterity, which leads to increased surgical precision and no tremor or fatigue. Comparable oncological results were documented for laparoscopic and open surgery. Currently, "conventional" laparoscopic liver surgery has limitations with respect to the treatment of lesions in the posterior-superior segments, and there are limited technical features for the reconstruction steps. These limitations might be overcome with the use of robotic surgery. The use of robotic surgery for hepatic procedures originated because of the technical potential to overcome several of the major technical limitations known from conventional laparoscopy and the possibility of performing more extended liver resections. Additionally, there is increasing evidence indicating that robotic hepatic surgery is feasible and safe in resections of the posterior segments. Studies showed that using the robotic technique is associated with a decreased or at least equal amount of intraoperative blood loss compared to that of the conventional laparoscopic or open technique. There is increasing evidence that robotic liver surgery might be as safe as conventional laparoscopic procedures in cancer cases in terms of resection margins, disease-free and overall survival. Furthermore, robotic surgery might be more favorable with respect to postoperative patient recovery. Despite promising results, still large, multicenter, randomized and prospective studies are needed to analyze the exact value of robotic liver surgery in patients with malignant liver tumors.
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Affiliation(s)
- René Fahrner
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07740, Jena, Germany.
| | - Falk Rauchfuß
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07740, Jena, Germany
| | - Astrid Bauschke
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07740, Jena, Germany
| | - Hermann Kissler
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07740, Jena, Germany
| | - Utz Settmacher
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07740, Jena, Germany
| | - Jürgen Zanow
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07740, Jena, Germany
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Outcomes of robotic liver resections for colorectal liver metastases. A multi-institutional analysis of minimally invasive ultrasound-guided robotic surgery. Surg Oncol 2019; 28:14-18. [PMID: 30851888 DOI: 10.1016/j.suronc.2018.10.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/18/2018] [Accepted: 10/30/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Current evidence supporting robotics to perform minimally invasive liver resection is based on single center case series reporting surgical outcomes in heterogeneous groups of patients. On the contrary, relatively scarce data specifically focusing on secondary hepatic malignancies is available. The objective of this study is to assess short- and long-term outcomes following liver resection for colorectal liver metastasis on a multi-institutional series of patients. METHODS All consecutive patients undergoing robotic surgery for colorectal liver metastasis at three different tertiary hospitals over a 10-year time frame were included in this analysis. All patients received ultrasound-guided liver resection according to tumor location following the principle of parenchymal sparing surgery. Perioperative, clinicopathologic and oncological outcomes were assessed. RESULTS A total of 59 patients underwent liver resection. There were 7 cases of conversion to open surgery. The postoperative complication rate was 27%, 5% being the rate of major morbidity. Overall, the mean postoperative hospital stay was 6 days and no mortality occurred. R0 resection was achieved for 92% of lesions. At a mean follow-up of 19 months, the 1-year and 3-year DFS was 83.5% and 41.9%, while the 1-year and 3-year OS was 90.4% and 66.1%, respectively. CONCLUSIONS Robotic liver surgery does not impair surgical outcome and oncological results in patients with liver metastases from colorectal cancer.
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Guadagni S, Furbetta N, Di Franco G, Palmeri M, Gianardi D, Bianchini M, Guadagnucci M, Pollina L, Masi G, Cremolini C, Falcone A, Mosca F, Di Candio G, Morelli L. Robotic-assisted surgery for colorectal liver metastasis: A single-centre experience. J Minim Access Surg 2019; 16:160-165. [PMID: 30777992 PMCID: PMC7176011 DOI: 10.4103/jmas.jmas_265_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Although minimally invasive surgery (MIS) of the liver is increasingly widespread, its role in the treatment of colorectal liver metastasis (CRLM) remains uncertain. In this setting, the role of robotic-assisted surgery (RAS) has not been significantly evaluated yet. The aim of this study was to report our experience with RAS for treatment of CRLM. Material and Methods: Prospectively collected surgical and oncologic data on all of the robotic-assisted liver resections for CRLM performed at our centre were retrieved from the institutional database and retrospectively analysed. Intra-operative ultrasound (US) was obtained with a dedicated robotic probe using the TilePro™ function. Results: Twenty patients underwent robotic-assisted resection of CRLM between May 2012 and April 2018. Six patients (30%) had multiple synchronous CRLM resections (median = 2; range 2–4). The tumour size averaged 3.0 ± 1.8 cm. All of the lesions were removed using a parenchymal-sparing approach, with R0 resection margins. Mean hospital stay was 4.7 ± 1.8 days. The mean follow-up was 22.5 ± 19.5 months. During the study period, there were no local recurrences, while 9 patients (45%) developed new systemic metastasis. All patients are still alive as of September 2018 with 1- and 3-year disease-free survival of 89.5% and 35.8%, respectively. Conclusions: In our experience, RAS for CRLM surgical treatment was feasible and played a positive role even in patients with multiple metastases and previous or synchronous surgery. RAS seemed to be oncologically effective in this setting, as no patients experienced local relapse in the treated area.
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Affiliation(s)
- Simone Guadagni
- Department of Surgery, Translational and New Technologies in Medicine, General Surgery Unit, University of Pisa, Pisa, Italy
| | - Niccolò Furbetta
- Department of Surgery, Translational and New Technologies in Medicine, General Surgery Unit, University of Pisa, Pisa, Italy
| | - Gregorio Di Franco
- Department of Surgery, Translational and New Technologies in Medicine, General Surgery Unit, University of Pisa, Pisa, Italy
| | - Matteo Palmeri
- Department of Surgery, Translational and New Technologies in Medicine, General Surgery Unit, University of Pisa, Pisa, Italy
| | - Desirée Gianardi
- Department of Surgery, Translational and New Technologies in Medicine, General Surgery Unit, University of Pisa, Pisa, Italy
| | - Matteo Bianchini
- Department of Surgery, Translational and New Technologies in Medicine, General Surgery Unit, University of Pisa, Pisa, Italy
| | - Martina Guadagnucci
- Department of Surgery, Translational and New Technologies in Medicine, General Surgery Unit, University of Pisa, Pisa, Italy
| | - Luca Pollina
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Surgical Pathology, University of Pisa, Pisa, Italy
| | - Gianluca Masi
- Department of Oncology, University Hospital of Pisa, Pisa, Italy
| | - Chiara Cremolini
- Department of Oncology, University Hospital of Pisa, Pisa, Italy
| | - Alfredo Falcone
- Department of Oncology, University Hospital of Pisa, Pisa, Italy
| | - Franco Mosca
- EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy
| | - Giulio Di Candio
- Department of Surgery, Translational and New Technologies in Medicine, General Surgery Unit, University of Pisa, Pisa, Italy
| | - Luca Morelli
- Department of Surgery, Translational and New Technologies in Medicine, General Surgery Unit; EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy
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Gheza F, Esposito S, Gruessner S, Mangano A, Fernandes E, Giulianotti PC. Reasons for open conversion in robotic liver surgery: A systematic review with pooled analysis of more than 1000 patients. Int J Med Robot 2018; 15:e1976. [DOI: 10.1002/rcs.1976] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 11/24/2018] [Accepted: 11/26/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Federico Gheza
- Department of Surgery; University of Illinois at Chicago; Chicago Illinois
| | - Sofia Esposito
- Department of Surgery; University of Illinois at Chicago; Chicago Illinois
| | - Stephan Gruessner
- Department of Surgery; University of Illinois at Chicago; Chicago Illinois
| | - Alberto Mangano
- Department of Surgery; University of Illinois at Chicago; Chicago Illinois
| | - Eduardo Fernandes
- Department of Surgery; University of Illinois at Chicago; Chicago Illinois
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23
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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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24
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Guerra F, Checcacci P, Vegni A, di Marino M, Annecchiarico M, Farsi M, Coratti A. Surgical and oncological outcomes of our first 59 cases of robotic pancreaticoduodenectomy. J Visc Surg 2018; 156:185-190. [PMID: 30115586 DOI: 10.1016/j.jviscsurg.2018.07.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Robotics has shown encouraging results for a number of technically demanding abdominal surgeries including pancreaticoduodenectomy, which has originally represented a relative contraindication to the application of the minimally-invasive technique. We aimed to investigate the perioperative, clinicopathologic, and oncological outcomes of robot-assisted pancreaticoduodenectomy by assessing a consecutive series of totally robotic procedures. METHODS All consecutive patients who underwent robotic pancreaticoduodenectomy were included in the present analysis. Perioperative, clinicopathologic and oncological outcomes were examined. In order to investigate the role of the learning curve, surgical outcomes were also used to compare the early and the late phase of our experience. RESULTS A total of 59 patients underwent surgery. Median hospital stay was 9 days (5 - 110), with an overall morbidity and mortality of 37% and 3%, respectively. Of note, the rate of clinically relevant pancreatic fistula was 11.8%. R0 resections were achieved in 96% of patients and the 3-year disease-free and overall survivals were 37.2 and 61.9%, respectively. Overall, surgical outcomes did not vary significantly between the first and the late phase of the series. CONCLUSIONS Robotic pancreaticoduodenectomy can be performed competently. It satisfies all features of oncological adequacy and may offer a number of advantages over standard procedures in terms of surgical results.
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Affiliation(s)
- F Guerra
- Division of Oncological and Robotic Surgery, Careggi University Hospital, Largo Brambilla, 2, 50134 Florence, Italy.
| | - P Checcacci
- Division of Oncological and Robotic Surgery, Careggi University Hospital, Largo Brambilla, 2, 50134 Florence, Italy
| | - A Vegni
- Division of Oncological and Robotic Surgery, Careggi University Hospital, Largo Brambilla, 2, 50134 Florence, Italy
| | - M di Marino
- Division of Oncological and Robotic Surgery, Careggi University Hospital, Largo Brambilla, 2, 50134 Florence, Italy
| | - M Annecchiarico
- Division of Oncological and Robotic Surgery, Careggi University Hospital, Largo Brambilla, 2, 50134 Florence, Italy
| | - M Farsi
- Division of Oncological and Robotic Surgery, Careggi University Hospital, Largo Brambilla, 2, 50134 Florence, Italy
| | - A Coratti
- Division of Oncological and Robotic Surgery, Careggi University Hospital, Largo Brambilla, 2, 50134 Florence, Italy
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Feasibility of robotic resection of gastrointestinal stromal tumors along the entire gastrointestinal tract. Updates Surg 2018; 71:695-700. [PMID: 30019164 DOI: 10.1007/s13304-018-0568-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 07/02/2018] [Indexed: 02/08/2023]
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26
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Magistri P, Tarantino G, Guidetti C, Assirati G, Olivieri T, Ballarin R, Coratti A, Di Benedetto F. Laparoscopic versus robotic surgery for hepatocellular carcinoma: the first 46 consecutive cases. J Surg Res 2017. [PMID: 28641762 DOI: 10.1016/j.jss.2017.05.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hepatocellular carcinoma has a growing incidence worldwide, and represents a leading cause of death in patients with cirrhosis. Nowadays, minimally invasive approaches are spreading in every field of surgery and in liver surgery as well. MATERIALS AND METHODS We retrospectively reviewed demographics, clinical, and pathologic characteristics and short-term outcomes of patients who had undergone minimally invasive resections for hepatocellular carcinoma at our institution between June 2012 and May 2016. RESULTS No significant differences in demographics and comorbidities were found between patients in the laparoscopic (n = 24) and robotic (n = 22) groups, except for the rates of cirrhotic patients (91.7% and 68.2%, respectively, P = 0.046). Perioperative data analysis showed that the operative time (mean, 211 and 318 min, respectively, P < 0.001) was the only parameter in favor of laparoscopy. Conversely, robotic-assisted resections were related to less Clavien I-II postoperative complications (22 cases versus 13 cases; P = 0.03). As regards resection margins, the two groups were similar with no statistically significant differences in rates of disease-free resection margins. CONCLUSIONS A modern hepatobiliary center should offer both open and minimally invasive approaches to liver disease to provide the best care for each patient, according to the individual comorbidities, risk factors, and personal quality of life expectations. Our results show that the robotic approach is a reliable tool for accurate oncologic surgery, comparable to the laparoscopic approach. Robotic surgery also allows the surgeon to safely approach liver segments that are difficult to resect in laparoscopy, namely segments I-VII-VIII.
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Affiliation(s)
- Paolo Magistri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy; Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza - University of Rome, Rome, Italy
| | - Giuseppe Tarantino
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristiano Guidetti
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Giacomo Assirati
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Tiziana Olivieri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto Ballarin
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Coratti
- Division of Surgical Oncology and Robotics, Azienda Ospedaliero-Universitaria di Careggi, Florence, Italy
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy.
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27
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Levi Sandri GB, de Werra E, Mascianà G, Colasanti M, Santoro R, D'Andrea V, Ettorre GM. Laparoscopic and robotic approach for hepatocellular carcinoma-state of the art. Hepatobiliary Surg Nutr 2016; 5:478-484. [PMID: 28124002 DOI: 10.21037/hbsn.2016.05.05] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Hepatocellular carcinoma (HCC) is the sixth most common malignant tumor worldwide and the most common primary liver cancer, in over 80% of cases HCC grown on a cirrhotic liver. Laparoscopic liver resection (LLR) is now worldwide accepted considering the excellent results shown. Minimally invasive surgical approach for HCC is increasing continuously and in specialized centers seems to become the first-line approach for those patients. The aim of this review presents and discusses state of the art in the laparoscopic and robotic surgical treatment of HCC. An electronic search was performed to identify all studies dealing with HCC resected with laparoscopy or robotic approach. Indications for laparoscopic resection, robotic assisted and totally robotic resection of HCC will be doubtless increased in future years. LLR and robotic approach for HCC is safe and feasible.
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Affiliation(s)
- Giovanni Battista Levi Sandri
- Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Lazio, Italy;; Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Edoardo de Werra
- Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Lazio, Italy
| | - Gianluca Mascianà
- Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Lazio, Italy
| | - Marco Colasanti
- Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Lazio, Italy
| | - Roberto Santoro
- Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Lazio, Italy
| | - Vito D'Andrea
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Maria Ettorre
- Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Lazio, Italy
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Levi Sandri GB, de Werra E, Mascianà G, Guerra F, Spoletini G, Lai Q. The use of robotic surgery in abdominal organ transplantation: A literature review. Clin Transplant 2016; 31. [PMID: 27726195 DOI: 10.1111/ctr.12856] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Giovanni B. Levi Sandri
- Division of General Surgery and Liver Transplantation; San Camillo Hospital; Rome Italy
- Department of Surgical Sciences; Sapienza University of Rome; Rome Italy
| | - Edoardo de Werra
- Division of General Surgery and Liver Transplantation; San Camillo Hospital; Rome Italy
| | - Gianluca Mascianà
- Division of General Surgery and Liver Transplantation; San Camillo Hospital; Rome Italy
| | - Francesco Guerra
- Division of Oncological and Robotic General Surgery; Careggi University Hospital; Florence Italy
| | - Gabriele Spoletini
- Department of HPB and Liver Transplant Surgery; Royal Free Hospital; London UK
| | - Quirino Lai
- Transplant Unit; Department of Surgery; University of L'Aquila; San Salvatore Hospital; L'Aquila Italy
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Guerra F, Bonapasta S, Di Marino M, Coratti F, Annecchiarico M, Coratti A. Réfection robotique d’une anastomose hépaticojéjunale pour sténose bénigne (avec vidéo). JOURNAL DE CHIRURGIE VISCÉRALE 2016; 153:404-405. [DOI: 10.1016/j.jchirv.2016.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Guerra F, Amore Bonapasta S, Di Marino M, Coratti F, Annecchiarico M, Coratti A. Surgical revision of benign hepaticojejunostomy stricture using a robotic system (with video). J Visc Surg 2016; 153:389-390. [PMID: 27671005 DOI: 10.1016/j.jviscsurg.2016.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lee JH, Han DH, Jang DS, Choi GH, Choi JS. Robotic extrahepatic Glissonean pedicle approach for anatomic liver resection in the right liver: techniques and perioperative outcomes. Surg Endosc 2015; 30:3882-8. [PMID: 26659247 DOI: 10.1007/s00464-015-4693-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 11/17/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Glissonean pedicle approach is one of the most popular methods of anatomic liver surgery. Liver surgeons have attempted to reproduce this method laparoscopically. In this study, we introduce our technique of the extrahepatic Glissonean approach for anatomic liver resections, using a robotic system, and report on short-term perioperative outcomes. METHODS From December 2008 to July 2014, 10 patients underwent robotic anatomic liver resection in the right liver. The procedure is as follows: (1) mobilization of the liver and isolation and clamping of a selected Glissonean pedicle; (2) transection of the liver parenchyma using a rubber band retraction technique; (3) division of the Glissonean pedicle after full exposure, followed by completion of parenchymal transection. RESULTS The median age of the patients was 52.50 (range 28-59) years, and seven were male. All patients had hepatocellular carcinoma. The types of resections performed were as follows: segmentectomy 6 (n = 1), segmentectomy of 4b + 5 ventral segments (n = 2), right posterior sectionectomy (n = 3), extended right hepatectomy (n = 1), extended right posterior sectionectomy (n = 2), and central bisectionectomy (n = 1). Only one case was converted to open surgery due to severe tumor adhesions on the diaphragm. The median operative time was 555 min (range 413-848), and the median estimated blood loss was 225 ml (range 30-700), with no perioperative transfusions. The overall complication rate was 70 % (grade I, 5; grade II, 1; grade III, 1; grade IV, 0). The median length of hospital stay postsurgery was 7 days (range 6-11). CONCLUSION Robotic surgery allowed for successful anatomic liver resections via an extrahepatic Glissonean pedicle approach in the right liver and can be safely performed in selected patients.
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Affiliation(s)
- Jin Ho Lee
- Division of Hepatopancreaticobiliary Surgery, Department of Surgery, Liver Cancer Clinic, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Ludlow Faculty Research Building #204, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
| | - Dai Hoon Han
- Division of Hepatopancreaticobiliary Surgery, Department of Surgery, Liver Cancer Clinic, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Ludlow Faculty Research Building #204, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
| | - Dong-Su Jang
- Department of Sculpture, Hongik University, Seoul, Korea
| | - Gi Hong Choi
- Division of Hepatopancreaticobiliary Surgery, Department of Surgery, Liver Cancer Clinic, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Ludlow Faculty Research Building #204, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
| | - Jin Sub Choi
- Division of Hepatopancreaticobiliary Surgery, Department of Surgery, Liver Cancer Clinic, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Ludlow Faculty Research Building #204, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
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