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Soyama A, Hamada T, Adachi T, Eguchi S. Current status and future perspectives of robotic liver surgery. Hepatol Res 2024; 54:786-794. [PMID: 38801309 DOI: 10.1111/hepr.14058] [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: 03/12/2024] [Revised: 04/17/2024] [Accepted: 05/07/2024] [Indexed: 05/29/2024]
Abstract
Robotic liver resection has been reported in case series since the early 2000s. The surgical robot is capable of precise operation using articulated forceps with seven degrees of freedom. The robot also eliminates tremors and provides a good surgical field with highly detailed 3D high-definition images. The clinical results demonstrating their usefulness have been increasing year by year. Initially, a shorter hospital stay was observed in comparison with open hepatectomy. Recent reports have also shown lower conversion and complication rates in comparison with laparoscopic hepatectomy. The clamp and crush method with bipolar forceps, sealing devices, ultrasonic shears, and the combined procedure of Cavitron ultrasonic surgical aspirator and robotic forceps as hybrid procedures have been reported as effective methods of parenchymal transection in robotic surgery. Theoretically, the advantages of the robotic platform allow for more complex liver resection around hilar structures and major blood vessels, as well as for vascular reconstruction or biliary reconstruction. The application of robotic liver surgery for hilar cholangiocarcinoma, living donor hepatectomy, and living donor liver transplantation has been reported. Robotic liver surgery is becoming more popular for certain indications; however, it is important to further evaluate its long-term surgical and oncological outcomes and costs in comparison with conventional laparoscopic and open liver surgery, based on accumulated experience.
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Affiliation(s)
- Akihiko Soyama
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takashi Hamada
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomohiko Adachi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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2
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He ZQ, Mao YL, Lv TR, Liu F, Li FY. A meta-analysis between robotic hepatectomy and conventional open hepatectomy. J Robot Surg 2024; 18:166. [PMID: 38587718 DOI: 10.1007/s11701-024-01882-1] [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: 02/04/2024] [Accepted: 02/22/2024] [Indexed: 04/09/2024]
Abstract
Current meta-analysis was performed to compare robotic hepatectomy (RH) with conventional open hepatectomy (OH) in terms of peri-operative and postoperative outcomes. PubMed, EMBASE, and the Cochrane Library were all searched up for comparative studies between RH and OH. RevMan5.3 software and Stata 13.0 software were used for statistical analysis. Nineteen studies with 1747 patients who received RH and 23,633 patients who received OH were included. Pooled results indicated that patients who received RH were generally younger than those received OH (P < 0.00001). Moreover, RH was associated with longer operative time (P = 0.0002), less intraoperative hemorrhage (P < 0.0001), lower incidence of intraoperative transfusion (P = 0.003), lower incidence of postoperative any morbidity (P < 0.00001), postoperative major morbidity (P = 0.0001), mortalities with 90 days after surgery (P < 0.0001), and shorter length of postoperative hospital stay (P < 0.00001). Comparable total hospital costs were acquired between RH and OH groups (P = 0.46). However, even at the premise of comparable R0 rate (P = 0.86), RH was associated with smaller resected tumor size (P < 0.00001). Major hepatectomy (P = 0.02) and right posterior hepatectomy (P = 0.0003) were less frequently performed in RH group. Finally, we concluded that RH was superior to OH in terms of peri-operative and postoperative outcomes. RH could lead to less intraoperative hemorrhage, less postoperative complications and an enhanced postoperative recovery. However, major hepatectomy and right posterior hepatectomy were still less frequently performed via robotic approach. Future more powerful well-designed studies are required for further exploration.
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Affiliation(s)
- Zhi-Qiang He
- Department of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ya-Ling Mao
- Day Surgery Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Tian-Run Lv
- Department of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Fei Liu
- Department of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Fu-Yu Li
- Department of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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McCarron FN, Vrochides D, Martinie JB. Current progress in robotic hepatobiliary and pancreatic surgery at a high-volume center. Ann Gastroenterol Surg 2023; 7:863-870. [PMID: 37927925 PMCID: PMC10623982 DOI: 10.1002/ags3.12737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/18/2023] [Accepted: 08/19/2023] [Indexed: 11/07/2023] Open
Abstract
There has been steady growth in the adoption of robotic HPB procedures world-wide over the past 20 years, but most of this increase has occurred only recently. Not surprisingly, the vast majority of robotics has been in the United States, with very few, select centers of adoption in Italy, South Korea, and Brazil, to name a few. We began our robotic HPB program in 2008, well before almost all other centers in the world, with the most notable exception of Giullianotti and colleagues. Our program began gradually, with smaller cases carefully selected to optimize the strengths of the original robotic platform and included complex biliary and pancreatic resections. We performed the first reported series of choledochojejunostomy for benign biliary strictures and first series of completion cholecystectomies. We began performing robotic distal pancreatectomies and longitudinal pancreaticojejunostomies, reporting our early experience for each of these procedures. Over time we progressed to robotic pancreaticoduodenectomies. Initially, these were performed with planned conversions until we were able to optimize efficiency. Now we have performed over 200 robotic whipples, reaching a 100% robotic completion rate by 2020. Finally, we have added robotic major hepatectomies, including resections for hilar cholangiocarcinoma to our repertoire. Since the program began, we have performed over 1600 robotic HPB cases. Outcomes from our program have shown superior lymph node harvest, lower DGE rates, shorter hospitalizations, and fewer rehab admissions with similar overall complications to open and laparoscopic procedures, signifying that over time a robotic HPB program is not only feasible but advantageous as well.
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Affiliation(s)
- Frances N. McCarron
- Department of Hepatobiliary and Pancreas SurgeryCarolinas Medical CenterCharlotteNorth CarolinaUSA
| | - Dionisios Vrochides
- Department of Hepatobiliary and Pancreas SurgeryCarolinas Medical CenterCharlotteNorth CarolinaUSA
| | - John B. Martinie
- Department of Hepatobiliary and Pancreas SurgeryCarolinas Medical CenterCharlotteNorth CarolinaUSA
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Wang J, Xu J, Lei K, You K, Liu Z. Prevalence and clinical significance of the Sg6/Sg7 intersegmental veins based on re-evaluation of the Couinaud classification for the right posterior portal vein. Updates Surg 2023; 75:1941-1948. [PMID: 37632610 DOI: 10.1007/s13304-023-01637-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/16/2023] [Indexed: 08/28/2023]
Abstract
Although Segment 6(Sg6) and Segment 7(Sg7) are two independent units, there are currently no clear anatomical boundary markers between Sg6 and Sg7. This study aimed to identify intersegmental veins (ISV) in the intersegmental plane of Sg6 and Sg7, and evaluate the prevalence of ISV, and its clinical significance in anatomical hepatectomy. We analyzed data from 180 patients undergoing abdominal computed tomography (CT) examination, and simultaneously performed 3D reconstruction models of the liver for each patient. The right posterior portal vein was analyzed and re-typed. Furthermore, the existence of ISV was defined, and prevalence and confluence patterns of ISV were analyzed. The author attempted to apply ISV to laparoscopic S6/S7 segmentectomy. We sorted data from the right posterior portal vein and divided it into six types. The ISV could be identified in 82.2% (148/180) of the patients, which were derived from the right hepatic vein (RHV) (91.9%) and right posterior inferior vein (IRHV) (8.1%). Ten ISV-guided laparoscopic Sg6/Sg7 segmentectomy were successfully carried out, seven patients underwent Sg6 segmentectomy, and three patients underwent Sg7 segmentectomy. There was no perioperative mortality. The median operative time was 223 min (range 181-260 min). The median blood loss was 200 ml (range 150-310 ml). The R0 resection rate was 100%. The ISV may be a candidate vessel to distinguish the boundary of the right posterior sector; it is expected to be a landmark in the liver parenchyma of anatomical hepatectomy.
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Affiliation(s)
- Jiaguo Wang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Yuzhong District, No. 76, Linjiang Road, Chongqing, 400010, China
| | - Jie Xu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Yuzhong District, No. 76, Linjiang Road, Chongqing, 400010, China
| | - Kai Lei
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Yuzhong District, No. 76, Linjiang Road, Chongqing, 400010, China
| | - Ke You
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Yuzhong District, No. 76, Linjiang Road, Chongqing, 400010, China
| | - Zuojin Liu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Yuzhong District, No. 76, Linjiang Road, Chongqing, 400010, China.
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Liu R, Abu Hilal M, Wakabayashi G, Han HS, Palanivelu C, Boggi U, Hackert T, Kim HJ, Wang XY, Hu MG, Choi GH, Panaro F, He J, Efanov M, Yin XY, Croner RS, Fong YM, Zhu JY, Wu Z, Sun CD, Lee JH, Marino MV, Ganpati IS, Zhu P, Wang ZZ, Yang KH, Fan J, Chen XP, Lau WY. International experts consensus guidelines on robotic liver resection in 2023. World J Gastroenterol 2023; 29:4815-4830. [PMID: 37701136 PMCID: PMC10494765 DOI: 10.3748/wjg.v29.i32.4815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/22/2023] [Accepted: 08/09/2023] [Indexed: 08/25/2023] Open
Abstract
The robotic liver resection (RLR) has been increasingly applied in recent years and its benefits shown in some aspects owing to the technical advancement of robotic surgical system, however, controversies still exist. Based on the foundation of the previous consensus statement, this new consensus document aimed to update clinical recommendations and provide guidance to improve the outcomes of RLR clinical practice. The guideline steering group and guideline expert group were formed by 29 international experts of liver surgery and evidence-based medicine (EBM). Relevant literature was reviewed and analyzed by the evidence evaluation group. According to the WHO Handbook for Guideline Development, the Guidance Principles of Development and Amendment of the Guidelines for Clinical Diagnosis and Treatment in China 2022, a total of 14 recommendations were generated. Among them were 8 recommendations formulated by the GRADE method, and the remaining 6 recommendations were formulated based on literature review and experts' opinion due to insufficient EBM results. This international experts consensus guideline offered guidance for the safe and effective clinical practice and the research direction of RLR in future.
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Affiliation(s)
- Rong Liu
- Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100000, China
| | - Mohammed Abu Hilal
- Hepatobiliary Pancreatic, Robotic & Laparoscopic Surgery, Poliambulanza Foundation Hospital, Brescia 25100, Italy
| | - Go Wakabayashi
- Center for Advanced Treatment of HBP Diseases, Ageo Central General Hospital, Saitama 362-0075, Japan
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Chinnusamy Palanivelu
- GEM Hospital & Research Centre, GEM Hospital & Research Centre, Coimbatore 641045, India
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa 56126, Italy
| | - Thilo Hackert
- Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg 20251, Germany
| | - Hong-Jin Kim
- Department of Surgery, Yeungnam University Hospital, Daegu 42415, South Korea
| | - Xiao-Ying Wang
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Ming-Gen Hu
- Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100000, China
| | - Gi Hong Choi
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Severance Hospital, Yonsei University, College of Medicine, Seoul 03722, South Korea
| | - Fabrizio Panaro
- Department of Surgery/Division of Robotic and HBP Surgery, Montpellier University Hospital-School of Medicine, Montpellier 34090, France
| | - Jin He
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21218, United States
| | - Mikhail Efanov
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow 111123, Russia
| | - Xiao-Yu Yin
- Department of Pancreatobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
| | - Roland S Croner
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg 39120, Germany
| | - Yu-Man Fong
- Department of Surgery, City of Hope Medical Center, Duarte, CA 91010, United States
| | - Ji-Ye Zhu
- Department of Hepatobiliary Surgery, Peking University People’s Hospital, Beijing 100000, China
| | - Zheng Wu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Chuan-Dong Sun
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Jae Hoon Lee
- Division of Hepatobiliary & Pancreatic surgery, Asan Medical Center, University of Ulsan College of Medicine, Ulsan 682, South Korea
| | - Marco V Marino
- General Surgery Department, F. Tappeiner Hospital, Merano 39012, Italy
| | - Iyer Shridhar Ganpati
- Hepatobiliary and Pancreatic Surgery, National University Hospital, Singapore 189969, Singapore
| | - Peng Zhu
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
| | - Zi-Zheng Wang
- Department of Hepatobiliary Surgery, Senior Department of Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100000, China
| | - Ke-Hu Yang
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Jia Fan
- Zhongshan Hospital, Fudan University, Shanghai 200000, China
| | - Xiao-Ping Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
| | - Wan Yee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
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Xuea Q, Wua J, Leia Z, Wanga Q, Fua J, Gaoa F. Robot-assisted versus open hepatectomy for liver tumors: Systematic review and meta-analysis. J Chin Med Assoc 2023; 86:282-288. [PMID: 36622784 PMCID: PMC9994574 DOI: 10.1097/jcma.0000000000000870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND This meta-analysis was conducted to evaluate the effectiveness and safety of robot-assisted hepatectomy (RAH) versus open hepatectomy (OH) for liver tumors (LT). METHODS A computer-based literature search was conducted to identify all randomized or nonrandomized controlled trials of RAH and OH in the treatment of LT from January 2000 to July 2022. Study-specific effect sizes and their 95% confidence intervals (CIs) were combined to calculate the pooled values, using a fixed-effects or random-effects model. RESULTS Eight studies were included, with a combined total of 1079 patients. Compared with the OH group, the RAH group was found to involve less blood loss (standardized mean difference [SMD] = -152.52 mL; 95% confidence interval [CI] = -266.85 to 38.18; p = 0.009), shorter hospital stay (SMD = -2.79; 95% CI = -4.19 to -1.40; p < 0.001), a lower rate of postoperative complications (odds ratio [OR] =0.67; 95% CI = 0.47-0.95; p = 0.02), and a lower recurrence rate (OR = 0.42; 95% CI = 0.23-0.77; p = 0.005). However, operative time was longer in the RAH group than in the OH group (SMD = 70.55; 95% CI = 37.58-103.53; p < 0.001). CONCLUSION This systematic review shows that RAH is safe and feasible in the treatment of LT.
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Affiliation(s)
- Qian Xuea
- Department of Hepatobiliary Surgery, People’s Hospital of Leshan, Sichuan Leshan, China
| | - Jianping Wua
- Department of Hepatobiliary Surgery, People’s Hospital of Leshan, Sichuan Leshan, China
| | - Zehua Leia
- Department of Hepatobiliary Surgery, People’s Hospital of Leshan, Sichuan Leshan, China
| | - Qing Wanga
- Department of Hepatobiliary Surgery, People’s Hospital of Leshan, Sichuan Leshan, China
| | - Jinqiang Fua
- Department of Hepatobiliary Surgery, People’s Hospital of Leshan, Sichuan Leshan, China
- Address correspondence. Dr. Jinqiang Fu and Dr. Fengwei Gao, Department of Hepatobiliary Surgery, People’s Hospital of Leshan, 238, Baita Street, Shizhong District, Sichuan Leshan, China. E-mail address: (J.-Q. Fu); (F.-W. Gao)
| | - Fengwei Gaoa
- Department of Hepatobiliary Surgery, People’s Hospital of Leshan, Sichuan Leshan, China
- Address correspondence. Dr. Jinqiang Fu and Dr. Fengwei Gao, Department of Hepatobiliary Surgery, People’s Hospital of Leshan, 238, Baita Street, Shizhong District, Sichuan Leshan, China. E-mail address: (J.-Q. Fu); (F.-W. Gao)
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Papadopoulou K, Dorovinis P, Kykalos S, Schizas D, Stamopoulos P, Tsourouflis G, Dimitroulis D, Nikiteas N. Short-Term Outcomes After Robotic Versus Open Liver Resection: A Systematic Review and Meta-analysis. J Gastrointest Cancer 2023; 54:237-246. [PMID: 35199298 DOI: 10.1007/s12029-022-00810-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Robotic liver surgery is a novel technique expanding the field of minimally invasive approaches. An increasing number of studies assess the outcomes of robotic liver resections (RLR). The aim of our meta-analysis is to provide an up-to-date comparison of RLR versus open liver resections (OLR), evaluating its safety and efficacy. MATERIALS AND METHODS A systematic search of MEDLINE, Scopus, Google Scholar, Cochrane, and Clinicaltrials.gov for articles published from January 2000 until January 2022 was undertaken. RESULTS Thirteen non-randomized retrospective and one prospective clinical study enlisting 1801 patients met our inclusion criteria, with 640 patients undergoing RLR and 1161 undergoing OLR. RLR resulted in significantly lower overall morbidity (p < 0.001), shorter length of hospital stay (p = 0.002), and less intraoperative blood loss (p < 0.001). Operative time was found to be significantly higher in the RLR group (p < 0.001). Blood transfusion requirements, R0 resection, and mortality rates presented no difference among the two groups. The cumulative rate of conversion was 5% in the RLR group. CONCLUSION The increasing experience in the implementation of the robot will undoubtedly generate more prospective randomized studies, necessary to assess its potential superiority over the traditional open approach, in a variety of hepatic lesions.
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Affiliation(s)
- Konstantina Papadopoulou
- Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Dorovinis
- Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
- 2nd Department of Propaedeutic Surgery, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17, 11527, Athens, Greece.
| | - Stylianos Kykalos
- Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- 2nd Department of Propaedeutic Surgery, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17, 11527, Athens, Greece
| | - Dimitrios Schizas
- Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- 1st Department of Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Paraskevas Stamopoulos
- 2nd Department of Propaedeutic Surgery, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17, 11527, Athens, Greece
| | - Gerasimos Tsourouflis
- Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- 2nd Department of Propaedeutic Surgery, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17, 11527, Athens, Greece
| | - Dimitrios Dimitroulis
- Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- 2nd Department of Propaedeutic Surgery, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17, 11527, Athens, Greece
| | - Nikolaos Nikiteas
- Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- 2nd Department of Propaedeutic Surgery, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17, 11527, Athens, Greece
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Wang MX, Xiang JF, Chen SK, Xiao LK. The safety and feasibility of laparoscopic right posterior sectionectomy vs. open approach: A systematic review and meta-analysis. Front Surg 2022; 9:1019117. [PMID: 36325043 PMCID: PMC9618829 DOI: 10.3389/fsurg.2022.1019117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 09/21/2022] [Indexed: 11/07/2022] Open
Abstract
Background Laparoscopic right posterior sectionectomy (LRPS) is one of the most technically challenging and potentially hazardous procedures in laparoscopic liver resection. Although some available literature works demonstrated the safety and feasibility of LRPS, these data are limited to reports from a single institution and a small sample size without support from evidence-based medicine. So, we performed a meta-analysis to assess further the safety and feasibility of LRPS by comparing it with open right posterior sectionectomy (ORPS). Methods MEDLINE, Embase, and Cochrane Library were systematically searched for eligible studies comparing LRPS and open approaches. Random and fixed-effects models were used to calculate outcome measures. Results Four studies involving a total of 541 patients were identified for inclusion: 250 in the LRPS group and 291 in the ORPS group. The postoperative complication and margin were not statistically different between the two groups (OR: 0.49, 95% CI: 0.18 to 1.35, P = 0.17) (MD: 0.05, 95% CI: −0.47 to 0.57, P = 0.86), respectively. LRPS had a significantly longer operative time and shorter hospital stay (MD: 140.32, 95% CI: 16.73 to 263.91, P = 0.03) (MD: −1.64, 95% CI: −2.56 to −0.72, P = 0.0005) respectively. Conclusion Data from currently available literature suggest that LRPS performed by an experienced surgeon is a safe and feasible procedure in selected patients and is associated with a reduction in the hospital stay.
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Affiliation(s)
- Meng-Xiao Wang
- Department of General Surgery, Chongqing General Hospital, Chongqing, China
| | - Ji-Feng Xiang
- Department of Hepatopancreatobiliary Surgery, Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, Chongqing, China
| | - Sheng-Kai Chen
- Department of Hepatopancreatobiliary Surgery, Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, Chongqing, China
| | - Lin-Kang Xiao
- Department of Hepatopancreatobiliary Surgery, Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, Chongqing, China,Correspondence: Lin-Kang Xiao
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9
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Ceccarelli G, Codacci-Pisanelli M, De Rosa M, Mariani L, Rocca A, Mazzucca D, Polistena A. Robot-Assisted Liver Resection and Cholecystectomy Using Indocyanine-Green for Intrahepatic Cholangiocarcinoma, in a Very Rare Anatomical Anomaly of ‘Bipartite Liver’. Surg Innov 2022; 29:488-493. [DOI: 10.1177/15533506221081116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Robotic hepatobiliary surgery has significantly developed worldwide with substantial clinical results. Hepatobiliary anatomical anomalies increase the complexity of hepatobiliary resection with a relevant risk of iatrogenic lesions. Among congenital liver anomalies, the ‘bipartite liver’ is an extremely rare condition which might be associated with complex surgical dissection of the hepatic hilum. We herein report a rare case of congenital ‘bipartite liver’ associated with a cholangiocarcinoma of segment VI and calculous cholecystitis. The patient underwent robot-assisted segmentectomy and cholecystectomy with the use of indocyanine-green cholangiography and intraoperative ultrasound. A challenging hilar dissection was performed using this approach. To the best of our knowledge, this is the first case reported that describes a robot-assisted liver resection and cholecystectomy in a patient having a cholangiocarcinoma associated with this rare liver anomaly. The robotic approach was safe and effective and the 3D preoperative imaging, as well as the intraoperative green-indocyanine cholangiography was extremely useful, especially during hilar dissection and cholecystectomy.
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Affiliation(s)
| | - Massimo Codacci-Pisanelli
- General and Laparoscopic Surgery, Department of Surgery Pietro Valdoni, Sapienza University of Rome, Italy
| | | | | | - Aldo Rocca
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, Italy
| | | | - Andrea Polistena
- General and Laparoscopic Surgery, Department of Surgery Pietro Valdoni, Sapienza University of Rome, Italy
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10
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Rocca A, Scacchi A, Cappuccio M, Avella P, Bugiantella W, De Rosa M, Costa G, Polistena A, Codacci-Pisanelli M, Amato B, Carbone F, Ceccarelli G. Robotic surgery for colorectal liver metastases resection: A systematic review. Int J Med Robot 2021; 17:e2330. [PMID: 34498805 DOI: 10.1002/rcs.2330] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/10/2021] [Accepted: 09/07/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The role of robotic surgery for colorectal cancer liver metastases (CRCLMs) has never been investigated in large series. METHODS A systematic literature review was carried out on PubMed and Cochrane libraries. RESULTS We selected nine studies between 2008 and 2021. Two hundred sixty-two patients were included. One hundred thirty-one patients underwent simultaneous resections. The mean blood loss was 309.4 ml (range, 200-450 ml), the mean operative time was 250.5 min (range, 198.5-449.0 min). The mean length of hospital stay was 7.98 days (range, 4.5 to 12 days). The overall postoperative mortality was 0.4%. The overall morbidity rate was 37.0%, Clavien-Dindo grade III-IV complications were 8.4%. The mean 3-year overall survival was 55.25% (range, 44.4-66.1%), the mean 3-year disease free survival was 37% (range, 33.3-41.9%) CONCLUSION: We can conclude that robotic-assisted surgery might be considered as a technical upgrade option for minimally invasive approach to CRCLM resections even for simultaneous operations and challenging cases.
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Affiliation(s)
- Aldo Rocca
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Andrea Scacchi
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Micaela Cappuccio
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Pasquale Avella
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Walter Bugiantella
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista, Foligno, Italy
| | - Michele De Rosa
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista, Foligno, Italy
| | - Gianluca Costa
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, Rome, Italy
| | - Andrea Polistena
- UOC General Surgery and Laparoscopic Surgery, Department of Surgery "P. Valdoni", Sapienza, University of Study of Rome, University Policlinic Umberto I, Rome, Italy
| | - Massimo Codacci-Pisanelli
- UOC General Surgery and Laparoscopic Surgery, Department of Surgery "P. Valdoni", Sapienza, University of Study of Rome, University Policlinic Umberto I, Rome, Italy
| | - Bruno Amato
- Division of General Surgery, Department of Clinical Medicine and Surgery, School of Medicine, University of Naples "Federico II", Naples, Italy
| | - Fabio Carbone
- Department of Advanced Biomedical Sciences, Università di Napoli - "Federico II", Naples, Italy
| | - Graziano Ceccarelli
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista, Foligno, Italy
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11
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Cipriani F, Fiorentini G, Magistri P, Fontani A, Menonna F, Annecchiarico M, Lauterio A, De Carlis L, Coratti A, Boggi U, Ceccarelli G, Di Benedetto F, Aldrighetti L. Pure laparoscopic versus robotic liver resections: Multicentric propensity score-based analysis with stratification according to difficulty scores. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 29:1108-1123. [PMID: 34291591 DOI: 10.1002/jhbp.1022] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/12/2021] [Accepted: 07/06/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The benefits of pure laparoscopic and robot-assisted liver resections (LLR and RALR) are known in comparison to open surgery. The aim of the present retrospective comparative study is to investigate the role of RALR and LLR according to different levels of difficulty. METHODS The institutional databases of six high-volume hepatobiliary centers were retrospectively reviewed. The study population was divided in two groups: LLR and RALR. The procedures were stratified for difficulty levels accordingly to three classifications. A propensity score matching was implemented to mitigate selection bias. Short-term outcomes were the object of comparison. RESULTS Nine hundred and thirty-six LLR and 403 RALR were collected. RALR exhibited fewer cases of intraoperative blood loss, lower transfusion and conversion rates (especially for oncological radicality) than LLR in the setting of highly difficult operations, whereas LLR had lower postoperative morbidity and fewer low-grade complications. For intermediate and low-difficulty resections, the intraoperative advantages of RALR gradually decreased to nonsignificant results and LLR remained associated with lower postoperative morbidity. CONCLUSION Robot-assisted liver resections do not show operative nor clinically significant benefits over LLR for low- and intermediate-difficulty resections. By reducing conversion rates, RALR can favour the operative feasibility of difficult resections possibly extending the indications of minimally invasive approaches for liver resection.
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Affiliation(s)
- Federica Cipriani
- Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Guido Fiorentini
- Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, Milan, Italy.,PhD School in Experimental Medicine, University of Pavia, Pavia, Italy
| | - Paolo Magistri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Fontani
- General Surgery Division, San Donato Hospital, Arezzo, Italy
| | - Francesca Menonna
- General and Transplant Surgery Division, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Mario Annecchiarico
- Division of Surgical Oncologic and Robotics, Department of Oncology, Careggi University Hospital, Florence, Italy
| | - Andrea Lauterio
- Department of General Surgery and Abdominal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Luciano De Carlis
- Department of General Surgery and Abdominal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Andrea Coratti
- Division of Surgical Oncologic and Robotics, Department of Oncology, Careggi University Hospital, Florence, Italy
| | - Ugo Boggi
- General and Transplant Surgery Division, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Graziano Ceccarelli
- General Surgery Division, San Donato Hospital, Arezzo, Italy.,General Minimally invasive and Robotic Surgery Division, San Matteo degli Infermi Hospital, Spoleto, Italy
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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12
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Vining CC, Skowron KB, Hogg ME. Robotic gastrointestinal surgery: learning curve, educational programs and outcomes. Updates Surg 2021; 73:799-814. [PMID: 33484423 DOI: 10.1007/s13304-021-00973-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 01/06/2021] [Indexed: 02/07/2023]
Abstract
The use of the robotic platform for gastrointestinal surgery was introduced nearly 20 years ago. However, significant growth and advancement has occurred primarily in the last decade. This is due to several advantages over traditional laparoscopic surgery allowing for more complex dissections and reconstructions. Several randomized controlled trials and retrospective reviews have demonstrated equivalent oncologic outcomes compared to open surgery with improved short-term outcomes. Unfortunately, there are currently no universally accepted or implemented training programs for robotic surgery and robotic surgery experience varies greatly. Additionally, several limitations to the robotic platform exist resulting in a distinct learning curve associated with various procedures. Therefore, implementation of robotic surgery requires a multidisciplinary team approach with commitment and investment from clinical faculty, operating room staff and hospital administrators. Additionally, there is a need for wider distribution of educational modules to train more surgeons and reduce the associated learning curve. This article will focus on the implementation of the robotic platform for surgery of the pancreas, stomach, liver, colon and rectum with an emphasis on the associated learning curve, educational platforms to develop proficiency and perioperative outcomes.
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Affiliation(s)
- Charles C Vining
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Kinga B Skowron
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Melissa E Hogg
- Department of Surgery, NorthShore University HealthSystem, Walgreens Building, Floor 2, 2650 Ridge Road, Evanston, IL, 60201, USA.
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13
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Mangano A, Valle V, Masrur MA, Bustos RE, Gruessner S, Giulianotti PC. Robotic liver surgery: literature review and future perspectives. Minerva Surg 2021; 76:105-115. [PMID: 33908236 DOI: 10.23736/s2724-5691.21.08495-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Minimally invasive liver resections (MILR) have been gaining popularity over the last decades. MILR provides superior peri-operative outcome. Despite these advantages, the penetrance of MILR in the clinical setting has been limited, and it was slowed down, among other factors, also by the laparoscopic technological limitations. EVIDENCE ACQUISITION A literature review has been carried out (Pubmed, Embase and Scopus platforms) focusing on the role of robotic surgery in MILR. EVIDENCE SYNTHESIS The literature review results are presented and our additional remarks on the topic are discussed. CONCLUSIONS Robotic MILR has been helping to expand the penetrance of MIS in liver surgery by making possible increasingly more challenging procedures. Minor resections still represent most of the robotic liver surgery data currently available. Robotic liver surgery is safe and effective, and it shows perioperative outcomes comparable with laparoscopic and open surgery. The oncological efficacy, within the limitations of the current level of evidence (mostly retrospective studies and literature heterogeneity), seems to show promising result. High quality prospective randomized studies, the use of prospective registry data, and multi-institutional efforts are needed.
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Affiliation(s)
- Alberto Mangano
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA -
| | - Valentina Valle
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Mario A Masrur
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Roberto E Bustos
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Stephan Gruessner
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Pier C Giulianotti
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
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14
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Ratti F, Rawashdeh A, Cipriani F, Primrose J, Fiorentini G, Abu Hilal M, Aldrighetti L. Intrahepatic cholangiocarcinoma as the new field of implementation of laparoscopic liver resection programs. A comparative propensity score-based analysis of open and laparoscopic liver resections. Surg Endosc 2021; 35:1851-1862. [PMID: 32342213 DOI: 10.1007/s00464-020-07588-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 04/22/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The aim of the present study is to analyze the outcomes of laparoscopic and open liver resections for (Intrahepatic CholangioCarcinoma) ICC in the modern era of laparoscopic liver surgery. METHODS Patients undergoing laparoscopic and open liver resections for ICC in two European referral centers were included. Finally, 104 patients from the open group and 104 patients from the laparoscopic group were compared after propensity scores matching according to seven covariates representative of patients and disease characteristics. Indications to surgery and short- and long-term outcomes were compared. RESULTS Operative time, number of retrieved nodes, rate, and depth of negative resection margins were comparable between the two groups. Blood loss was lower in the MILS (150 ± 100 mL, mean ± SD) compared with the Open group (350 ± 250 mL, p = 0.030). Postoperative complications occurred in 14.4% of patients in the MILS and in the 24% of patients in the Open group (p = 0.02). There were no significant differences in long-term outcomes between groups. CONCLUSIONS Our results confirm feasibility, safety, and oncological efficiency of the laparoscopic approach in the management of ICC. However, this surgery is often complex and should be only considered in centers with large experience in laparoscopic liver surgery.
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Affiliation(s)
- Francesca Ratti
- Hepatobiliary Surgery Division, San Raffaele Hospital, Via Olgettina 60, 20132, Milano, Italy.
| | - Arab Rawashdeh
- Department of Hepatobiliary and Pancreatic Surgery, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | - Federica Cipriani
- Hepatobiliary Surgery Division, San Raffaele Hospital, Via Olgettina 60, 20132, Milano, Italy
| | - John Primrose
- Department of Hepatobiliary and Pancreatic Surgery, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | - Guido Fiorentini
- Hepatobiliary Surgery Division, San Raffaele Hospital, Via Olgettina 60, 20132, Milano, Italy
| | - Mohammed Abu Hilal
- Department of Hepatobiliary and Pancreatic Surgery, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, San Raffaele Hospital, Via Olgettina 60, 20132, Milano, Italy
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15
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Cipriani F, Ratti F, Fiorentini G, Reineke R, Aldrighetti L. Systematic review of perioperative and oncologic outcomes of minimally-invasive surgery for hilar cholangiocarcinoma. Updates Surg 2021; 73:359-377. [PMID: 33615423 DOI: 10.1007/s13304-021-01006-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/10/2021] [Indexed: 12/12/2022]
Abstract
Most surgeons have traditionally been reluctant toward minimally-invasive surgery for bile duct tumors. This study aimed to perform a systematic literature review on perioperative and oncologic results of pure laparoscopic and robotic curative-intent surgery for hilar cholangiocarcinoma. According to the PRISMA statement, a systematic review was conducted into Pubmed, EMBASE and Cochrane. A critical appraisal of study was performed according to the Joanna Briggs Institute tools. Nineteen studies (12 on pure laparoscopy and 7 on robotics) were included: 7 case reports, 9 case series, 3 case-control (193 patients). The pooled conversion, morbidity, biliary leak and mortality rates were 5.5%, 43%, 16.4% and 4%. The weighted mean of operative time, blood loss and postoperative stay were 388 min, 446 mL and 14 days. For pure laparoscopy, the pooled R0 rate was 86%; overall survival and disease-free survival rates ranged from 85 to 100% and from 80 to 100% (median observation time 6-18 months). For robotic surgeries, the pooled R0 rate was 69% and overall survival rates ranged from 90 to 100% (median observation time 5-15 months). Case reports were overall of high quality, case series of moderate / high-quality, case-control studies ranged from low to high quality. In selected patients, minimally-invasive surgery for Klatskin tumors appears feasible, safe, satisfactory for perioperative outcomes and adequate for oncologic results. However, the results are based on few studies, limited in patient numbers and with allocation criteria more restrictive than open, reporting short follow-up and mainly with non-comparative design: evidence of higher quality is recommended.
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Affiliation(s)
- Federica Cipriani
- Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Guido Fiorentini
- Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Raffaella Reineke
- Department of Anesthesiology and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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16
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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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17
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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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18
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Zhao Z, Yin Z, Li M, Jiang N, Liu R. State of the art in robotic liver surgery: a meta-analysis. Updates Surg 2020; 73:977-987. [PMID: 33146887 DOI: 10.1007/s13304-020-00906-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 10/20/2020] [Indexed: 01/05/2023]
Abstract
Although the number of robotic hepatectomy (RH) performed is increasing, few studies have reported its efficacy in comparison with the conventional surgical modalities. The aim of this meta-analysis was to evaluate the perioperative results of RH vs. open hepatectomy (OH) and RH vs. laparoscopic hepatectomy (LH). We systematically searched for English papers published in PubMed (Medline), Embase, and Cochrane library before March 1, 2020. A total of 39 papers and 2999 patients were eventually included. Among the included patients, 1249, 1010, and 740 underwent RH, LH, and OH, respectively. Compared with OH, the operation time was significantly increased but the intraoperative blood loss, blood transfusion rate, incidence of severe complications, and length of postoperative hospitalization were significantly reduced in patients with RH. However, there was no significant difference in the use of Pringle maneuver and overall incidence of complications. Compared with LH, the operation time was significantly increased, and the intraoperative blood loss was also more in RH. However, there were no differences in blood transfusion rate, use of Pringle maneuver, incidence of complications, incidence of severe complications, and length of postoperative hospitalization between the two groups. A longer operation time remains the main shortcoming of RH. However, based on the perioperative clinical efficacy, we conclude that RH is comparable to LH but is better than OH for selected patients.
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Affiliation(s)
- Zhiming Zhao
- The Second Department of Hepatopancreatobiliary Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhuzeng Yin
- The Second Department of Hepatopancreatobiliary Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Mengyang Li
- Department of Hepatobiliary Surgery, The Fourth Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Nan Jiang
- The Second Department of Hepatopancreatobiliary Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Rong Liu
- The Second Department of Hepatopancreatobiliary Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China.
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19
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Rubinkiewicz M, Mizera M, Małczak P, Gajewska N, Torbicz G, Su M, Karcz K, Pędziwiatr M. Laparoscopic versus open liver resections of posterolateral liver segments - a systematic review and meta-analysis. Wideochir Inne Tech Maloinwazyjne 2020; 15:395-402. [PMID: 32904535 PMCID: PMC7457196 DOI: 10.5114/wiitm.2020.94268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 02/23/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Laparoscopic resection has become an accepted approach to liver tumour surgery. However, it is considered difficult, especially in unfavourably located lesions. AIM To compare the outcomes of laparoscopic (LLR) and open liver resection (OLR) of posterolateral segments. MATERIAL AND METHODS We searched the PubMed, EMBASE, and Scopus databases from inception to 30 September 2019. Full text articles and conference abstracts were included for further analysis. This review follows the PRISMA guidelines. RESULTS From 643 articles, 15 studies (N = 1196 patients) were included in the meta-analysis. All of them were non-randomised. Our findings showed that LLR had significantly lowered overall morbidity compared to OLR (MD = 0.66; 95% CI: 0.51-0.86; p = 0.002). Length of hospital stay (MD = 2.48; 95% CI: -3.87, -1.08; p < 0.001) was also shorter in the LLR group. Operative time (MD = 55.65; 95% CI: 24.14-87.16; p < 0.001) was significantly shorter in the OLR group. In terms of blood loss, major complications, R0 resection rates, and resection margin, there were no significant differences. CONCLUSIONS Our meta-analysis showed that the laparoscopic approach to resections of posterolateral liver segments is beneficial. However, the results are based on non-randomised trials, and further research is needed to fully establish their clinical application.
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Affiliation(s)
- Mateusz Rubinkiewicz
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Mizera
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr Małczak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Natalia Gajewska
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Grzegorz Torbicz
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Michael Su
- Faculty of Medicine, Jagiellonian University, Krakow, Poland
| | - Konrad Karcz
- Clinic of General, Visceral and Transplantation Surgery, Ludwig Maximilian University, Munich, Germany
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
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20
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Lim C, Goumard C, Salloum C, Tudisco A, Napoli N, Boggi U, Azoulay D, Scatton O. Outcomes after 3D laparoscopic and robotic liver resection for hepatocellular carcinoma: a multicenter comparative study. Surg Endosc 2020; 35:3258-3266. [DOI: 10.1007/s00464-020-07762-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/25/2020] [Indexed: 12/13/2022]
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21
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Ratti F, Cipriani F, Fiorentini G, Catena M, Paganelli M, Aldrighetti L. Reappraisal of the advantages of laparoscopic liver resection for intermediate hepatocellular carcinoma within a stage migration perspective: Propensity score analysis of the differential benefit. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 27:510-521. [PMID: 32189450 DOI: 10.1002/jhbp.736] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/02/2020] [Accepted: 03/15/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The aim of the present study was to analyze the outcome of laparoscopic approach specifically in patients with Intermediate-stage disease and to define the differential benefit with Early-stage patients. METHODS Six hundred twenty-two resections for HCC were dichotomized according to staging (Early and Intermediate) and to approach and then matched in a 1:1 ratio using propensity scores to obtain four groups (E-MILS and E-Open, including 104 patients respectively; Int-MILS and Int-Open, including 142 patients, respectively). The differential benefit associated with the minimally invasive technique was evaluated between intermediate-stage and early-stage patients taking into account blood loss and morbidity rate as outcome indicators. RESULTS Laparoscopic approach resulted in a statistically significant lower blood loss, reduced morbidity, reduced incidence of hepatic decompensation and shorter time for functional recover and length of stay. The evaluation of the differential benefit showed a greater advantage of laparoscopic approach in Intermediate-stage patients compared with Early-stage patients, both in terms of blood loss and morbidity rate. CONCLUSIONS The favorable biological scenario associated with laparoscopic approach allows to obtain enhanced benefits in the setting of more advanced liver disease. The push towards minimal invasiveness and the incremental benefit associated with it could potentially promote stage migration in suitable patients.
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Affiliation(s)
- Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy
| | - Federica Cipriani
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy
| | - Guido Fiorentini
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy
| | - Marco Catena
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy
| | - Michele Paganelli
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy
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22
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Perihilar cholangiocarcinoma: are we ready to step towards minimally invasiveness? Updates Surg 2020; 72:423-433. [DOI: 10.1007/s13304-020-00752-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/19/2020] [Indexed: 12/17/2022]
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23
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Lee JW, Choi SH, Kim S, Kwon SW. Laparoscopic liver resection for segment VII lesion using a combination of rubber band retraction method and flexible laparoscope. Surg Endosc 2019; 34:954-960. [PMID: 31139981 DOI: 10.1007/s00464-019-06864-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 05/18/2019] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Laparoscopic liver resection (LLR) for tumors involving segment VII has been considered a contraindication. Herein, our proposed laparoscopic technique for segment VII lesions using a rubber band retraction method and flexible laparoscope is introduced. METHODS A combination of elastic rubber band retraction method and flexible laparoscope was applied to access segment VII lesion. The perioperative outcomes and pathologic results were compared between patients with segment VII lesions (group 1) and patients with tumors in other segments (group 2) to evaluate feasibility and safety of the proposed laparoscopic approach for segment VII lesions. RESULTS Among 167 patients who underwent LLR from May 2014 to October 2017, the study population included 17 patients with tumors in segment VII (group 1) and 66 patients with tumors in other segments (group 2). The demographics of the two groups were comparable. One open conversion occurred in group 2 due to bleeding. The mean tumor size was 2.6 ± 1.0 and 2.5 ± 1.5 cm (p = 0.392) and surgical margin was 1.2 ± 0.7 and 1.3 ± 1.2 cm (p = 0.344) in group 1 and group 2, respectively. The mean operation time was 151 ± 63 and 131 ± 57 min (p = 0.596) and estimated mean blood loss was 294 ± 281 and 306 ± 405 mL (p = 0.610), in group 1 and group 2, respectively. The mean postoperative hospital stay was 6.1 ± 1.5 and 6.4 ± 2.7 days (p = 0.064) in group 1 and group 2. Two postoperative complications in both groups and no postoperative mortality occurred. CONCLUSION The combination technique of rubber band retraction and flexible laparoscopic camera allowed feasible and safe LLR for segment VII lesions that showed postoperative outcomes comparable to other segment lesions.
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Affiliation(s)
- Jin Woo Lee
- Division of Hepatobiliary and Pancreas, Department of Surgery, CHA Bundang Medical Center, CHA University, Cancer Research Building #524, 59 Yatap-ro, Bundang-gu, Seongnam-Si, Gyeonggi-do, 13496, Korea
| | - Sung Hoon Choi
- Division of Hepatobiliary and Pancreas, Department of Surgery, CHA Bundang Medical Center, CHA University, Cancer Research Building #524, 59 Yatap-ro, Bundang-gu, Seongnam-Si, Gyeonggi-do, 13496, Korea.
| | - Seungki Kim
- Division of Hepatobiliary and Pancreas, Department of Surgery, CHA Bundang Medical Center, CHA University, Cancer Research Building #524, 59 Yatap-ro, Bundang-gu, Seongnam-Si, Gyeonggi-do, 13496, Korea
| | - Sung Won Kwon
- Division of Hepatobiliary and Pancreas, Department of Surgery, CHA Bundang Medical Center, CHA University, Cancer Research Building #524, 59 Yatap-ro, Bundang-gu, Seongnam-Si, Gyeonggi-do, 13496, Korea
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24
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Liu R, Wakabayashi G, Kim HJ, Choi GH, Yiengpruksawan A, Fong Y, He J, Boggi U, Troisi RI, Efanov M, Azoulay D, Panaro F, Pessaux P, Wang XY, Zhu JY, Zhang SG, Sun CD, Wu Z, Tao KS, Yang KH, Fan J, Chen XP. International consensus statement on robotic hepatectomy surgery in 2018. World J Gastroenterol 2019; 25:1432-1444. [PMID: 30948907 PMCID: PMC6441912 DOI: 10.3748/wjg.v25.i12.1432] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/06/2019] [Accepted: 03/12/2019] [Indexed: 02/06/2023] Open
Abstract
The robotic surgical system has been applied in liver surgery. However, controversies concerns exist regarding a variety of factors including the safety, feasibility, efficacy, and cost-effectiveness of robotic surgery. To promote the development of robotic hepatectomy, this study aimed to evaluate the current status of robotic hepatectomy and provide sixty experts’ consensus and recommendations to promote its development. Based on the World Health Organization Handbook for Guideline Development, a Consensus Steering Group and a Consensus Development Group were established to determine the topics, prepare evidence-based documents, and generate recommendations. The GRADE Grid method and Delphi vote were used to formulate the recommendations. A total of 22 topics were prepared analyzed and widely discussed during the 4 meetings. Based on the published articles and expert panel opinion, 7 recommendations were generated by the GRADE method using an evidence-based method, which focused on the safety, feasibility, indication, techniques and cost-effectiveness of hepatectomy. Given that the current evidences were low to very low as evaluated by the GRADE method, further randomized-controlled trials are needed in the future to validate these recommendations.
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Affiliation(s)
- Rong Liu
- Second Department of Hepatopancreatobiliary Surgery, Chinese People’s Liberation Army (PLA) General Hospital, Beijing 100853, China
| | - Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Ageo 362-8588, Japan
| | - Hong-Jin Kim
- Department of Surgery, Yeungnam University Hospital, Daegu 705-703, South Korea
| | - Gi-Hong Choi
- Division of Hepatobiliary Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul 03722, South Korea
| | - Anusak Yiengpruksawan
- Minimally Invasive Surgery Division, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Yuman Fong
- Department of Surgery, City of Hope Medical Center, Duarte, CA 91010, United States
| | - Jin He
- Department of Surgery, the Johns Hopkins Hospital, Baltimore, MD 21287, United States
| | - Ugo Boggi
- Division of General and Transplant Surgery, Pisa University Hospital, Pisa 56124, Italy
| | - Roberto I Troisi
- Department of Clinical Medicine and Surgery, Federico II University, Naples 80131, Italy
| | - Mikhail Efanov
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow 11123, Russia
| | - Daniel Azoulay
- Hepato-Biliary Center, Paul Brousse University Hospital, Villejuif 94000, France
- Hepato-Biliary Center, Tel Hashomer University Hospital, Tel Aviv, Israel
| | - Fabrizio Panaro
- Department of Surgery/Division of HBP Surgery and Transplantation, Montpellier University Hospital—School of Medicine, Montpellier 34000, France
| | - Patrick Pessaux
- Head of the Hepato-biliary and pancreatic surgical unit, Nouvel Hôpital Civil, Strasbourg Cedex 67091, France
| | - Xiao-Ying Wang
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Ji-Ye Zhu
- Department of Hepatobiliary Surgery, Peking University People’s Hospital, Beijing 100044, China
| | - Shao-Geng Zhang
- Department of Hepatobiliary Surgery, 302 Hospital of Chinese PLA, Beijing 100039, China
| | - Chuan-Dong Sun
- Department of Hepatobiliary and Pancreatic Surgery, the Affiliated Hospital of Qingdao University, Qingdao 266071, Shandong Province, China
| | - Zheng Wu
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Kai-Shan Tao
- Department of Hepatobiliary Surgery, Xijing Hospital, the Fourth Military Medical University, Xi’an 710032, Shaanxi Province, China
| | - Ke-Hu Yang
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Jia Fan
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xiao-Ping Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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25
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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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26
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Machairas N, Papaconstantinou D, Tsilimigras DI, Moris D, Prodromidou A, Paspala A, Spartalis E, Kostakis ID. Comparison between robotic and open liver resection: a systematic review and meta-analysis of short-term outcomes. Updates Surg 2019; 71:39-48. [PMID: 30719624 DOI: 10.1007/s13304-019-00629-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 01/28/2019] [Indexed: 12/13/2022]
Abstract
Minimally invasive liver surgery has evolved significantly during the last 2 decades. A growing number of published studies report outcomes from robotic liver resections (RLR). The aim of our meta-analysis was to evaluate short-term outcomes after RLR vs. open liver resection (OLR). A systematic search of Medline, Scopus, Google Scholar, Cochrane CENTRAL Register of Controlled Trials and Clinicaltrials.gov databases for articles published from January 2000 until November 2018 was performed. Ten non-randomized retrospective clinical studies comprising a total of 1248 patients were included in our meta-analysis. Four hundred and fifty-eight patients underwent RLR and 790 underwent OLR. RLRs were associated with lower overall morbidity rates (p =0.006) and shorter hospital stay (p <0.00001), whereas OLRs were associated with shorter operative time (p =0.003). No differences were shown between the two groups with regard to blood loss, blood transfusion requirements, R0 resection and mortality rates. Cumulative conversion rate was 4.6% in the RLR group. Due to limited available data, further prospective randomized studies are needed to better determine the potential beneficial role of the robotic approach in the treatment of malignant and benign hepatic tumors.
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Affiliation(s)
- Nikolaos Machairas
- 3rd Department of Surgery, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Rimini Str. 1, 12462, Athens, Greece.
| | - Dimetrios Papaconstantinou
- 3rd Department of Surgery, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Rimini Str. 1, 12462, Athens, Greece
| | - Diamantis I Tsilimigras
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens, Greece
| | - Dimitrios Moris
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens, Greece.,Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Anastasia Prodromidou
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens, Greece
| | - Anna Paspala
- 3rd Department of Surgery, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Rimini Str. 1, 12462, Athens, Greece
| | - Eleftherios Spartalis
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens, Greece
| | - Ioannis D Kostakis
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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27
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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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28
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Nota CL, Woo Y, Raoof M, Boerner T, Molenaar IQ, Choi GH, Kingham TP, Latorre K, Borel Rinkes IHM, Hagendoorn J, Fong Y. Robotic Versus Open Minor Liver Resections of the Posterosuperior Segments: A Multinational, Propensity Score-Matched Study. Ann Surg Oncol 2018; 26:583-590. [PMID: 30334196 DOI: 10.1245/s10434-018-6928-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Minor liver resections of posterosuperior segments (1, 4A, 7, 8) are challenging to perform laparoscopically and are mainly performed using an open approach. We determined the feasibility of robotic resections of posterosuperior segments and compared short-term outcomes with the open approach. METHODS Data on open and robotic minor (≤ 3 segments) liver resections including the posterosuperior segments, performed between 2009 and 2016, were collected retrospectively from four hospitals. Robotic and open liver resections were compared, before and after propensity score matching. RESULTS In total, 51 robotic and 145 open resections were included. After matching, 31 robotic resections were compared with 31 open resections. Median hospital stay was 4 days (interquartile range [IQR] 3-7) for the robotic group, versus 8 days (IQR 6-10) for the open group (p < 0.001). Median operative time was 222 min (IQR 164-505) for robotic cases versus 231 min (IQR 190-301) for open cases (p = 0.668). Median estimated blood loss was 200 mL (IQR 100-400) versus 300 mL (IQR 125-750), respectively (p = 0.212). In the robotic group, one patient (3%) had a major complication, versus three patients (10%) in the open group (p = 0.612). Readmissions were similar-10% in the robotic group versus 6% in the open group (p > 0.99). There was no mortality in either group. CONCLUSION Minor robotic liver resections of the posterosuperior segments are safe and feasible and display a shorter length of stay than open resections in selected patients at expert centers.
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Affiliation(s)
- Carolijn L Nota
- Department of Surgery, City of Hope National Medical Center, City of Hope Hospital Duarte, Duarte, CA, USA.,Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yanghee Woo
- Department of Surgery, City of Hope National Medical Center, City of Hope Hospital Duarte, Duarte, CA, USA
| | - Mustafa Raoof
- Department of Surgery, City of Hope National Medical Center, City of Hope Hospital Duarte, Duarte, CA, USA
| | - Thomas Boerner
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - I Quintus Molenaar
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gi Hong Choi
- Department of Surgery, Yonsei University Severance Hospital, Seoul, Republic of Korea
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Karen Latorre
- Department of Surgery, Yonsei University Severance Hospital, Seoul, Republic of Korea
| | | | - Jeroen Hagendoorn
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yuman Fong
- Department of Surgery, City of Hope National Medical Center, City of Hope Hospital Duarte, Duarte, CA, USA.
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29
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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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30
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Wong DJ, Wong MJ, Choi GH, Wu YM, Lai PB, Goh BKP. Systematic review and meta-analysis of robotic versus open hepatectomy. ANZ J Surg 2018; 89:165-170. [PMID: 29943881 DOI: 10.1111/ans.14690] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/13/2018] [Accepted: 04/17/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND To date, there are few studies comparing the outcomes of robotic hepatectomy (RH) versus open hepatectomy (OH). We report the first systematic review and meta-analysis comparing the outcomes of RH versus OH. METHODS A systemic review was performed of all comparative studies of RH versus OH that reported the perioperative outcome(s) of interest. RESULTS Seven retrospective cohort studies were included. There was no significant difference in patients' baseline characteristics. RH was associated with a longer operation time (mean difference (MD) 61.47 min; 95% confidence interval (CI) (7.03, 115.91); P = 0.03), shorter hospital stay (MD -2.57 days; 95% CI (-3.31, -1.82); P < 0.001), lower costs, less overall (risk ratio (RR) 0.63; 95% CI (0.46, 0.86); P = 0.004), minor (RR 0.64; 95% CI (0.43, 0.95); P = 0.03) and major (RR 0.45; 95% CI (0.22, 0.94); P = 0.03) post-operative complications compared to OH. CONCLUSION RH had superior perioperative outcomes and was not cost prohibitive compared to OH, but had longer operation times.
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Affiliation(s)
- Daniel J Wong
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore.,Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Michelle J Wong
- Medical Program, The University of Sydney, Sydney, New South Wales, Australia
| | - Gi Hong Choi
- Division of Hepatopancreatobiliary Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Yao Ming Wu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Paul B Lai
- Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore.,Duke-NUS Medical School, Singapore
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31
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Wang WH, Kuo KK, Wang SN, Lee KT. Oncological and surgical result of hepatoma after robot surgery. Surg Endosc 2018; 32:3918-3924. [PMID: 29488090 DOI: 10.1007/s00464-018-6131-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 02/23/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Most liver resections are currently performed using an open approach. Robotic hepatectomy has been suggested as a safe and effective approach for hepatocellular carcinoma; however, studies regarding oncological and surgical outcomes are still limited. Accordingly, we performed this study to compare the surgical and oncological outcomes between robotic and open approaches. METHODS Between June, 2013 and July, 2016, a total of 63 HCC patients undergoing robotic hepatectomy, and 177 patients undergoing open hepatectomy were included in this study to assess the surgical and oncological outcomes after hepatectomy. The data of demographic, clinical features, hepatitis profile, tumor characters, TNM stage, surgical type, pathological outcomes, and postoperative results were collected prospectively and analyzed retrospectively. RESULTS The demographic and clinical features of patients with HCC in both groups were statistically comparable. The robotic group had longer operative times (296 ± 84 vs. 182 ± 51 min, p = 0.032). The postoperative complications rate was slightly lower in the robotic group (11.1 vs. 15.3%, p = 0.418). The rate of Ro resection was similar in both groups (93.7 vs. 96%, p = 0.56). The length of hospital stay was significantly shorter in the robotic group (6.21 ± 2.06 vs. 8.18 ± 6.99 days, p = 0.001). The overall recurrence rate of HCC was lower in the robotic group (27 vs. 37.3%, p = 0.140). The 1, 2, 3 year disease-free survival rates were 72.5, 64.3, and 61.6%, respectively, for the open group, while they were 77.8, 71.9, and 71.9%, respectively, for the robotic group, (p = 0.325). The 1, 2, 3 year overall survival rates were 95.4, 92.3, and 92.3%, respectively, for the open group, while they were 100, 97.7, and 97.7%, respectively, for the robotic group (p = 0.137). CONCLUSION Robotic surgery is a safe and feasible procedure for liver resection in selected patients. The oncological and surgical outcomes of robotic hepatectomy were comparable to open surgery. The robotic hepatectomy carried significantly shorter length of hospital stay.
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Affiliation(s)
- Wen-Hsiuan Wang
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzy-you 1st Rd, Kaohsiung, 807, Taiwan
| | - Kung-Kai Kuo
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzy-you 1st Rd, Kaohsiung, 807, Taiwan
| | - Shen-Nien Wang
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzy-you 1st Rd, Kaohsiung, 807, Taiwan
| | - King-Teh Lee
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzy-you 1st Rd, Kaohsiung, 807, Taiwan.
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Gonzalez-Ciccarelli LF, Quadri P, Daskalaki D, Milone L, Gangemi A, Giulianotti PC. [Robotic approach to hepatobiliary surgery. German version]. Chirurg 2018; 88:19-28. [PMID: 27470057 DOI: 10.1007/s00104-016-0223-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Robot-assisted hepatobiliary surgery has been steadily growing in recent years. It represents an alternative to the open and laparoscopic approaches in selected patients. Endowristed instruments and enhanced visualization provide important advantages in terms of selective bleeding control, microsuturing, and dissection. Cholecystectomies and minor hepatectomies are being performed with comparable results to open and laparoscopic surgery. Even complex procedures, such as major and extended hepatectomies, can have excellent outcomes, in expert hands. The addition of indocyanine green fluorescence provides an additional advantage for recognition of the vascular and biliary anatomy. Future innovations will allow for expanding its use and indications. Robotic surgery has become a very important component of modern minimally invasive surgery and the development of new robotic technology will facilitate a broader adoption of this technique.
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Affiliation(s)
- L F Gonzalez-Ciccarelli
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois Hospital and Health Sciences System, 840 S Wood St, 60612, Chicago, IL, USA
| | - P Quadri
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois Hospital and Health Sciences System, 840 S Wood St, 60612, Chicago, IL, USA
| | - D Daskalaki
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois Hospital and Health Sciences System, 840 S Wood St, 60612, Chicago, IL, USA
| | - L Milone
- Brooklyn Hospital Center, Brooklyn, NY, USA
| | - A Gangemi
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois Hospital and Health Sciences System, 840 S Wood St, 60612, Chicago, IL, USA
| | - P C Giulianotti
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois Hospital and Health Sciences System, 840 S Wood St, 60612, Chicago, IL, USA.
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Hu L, Yao L, Li X, Jin P, Yang K, Guo T. Effectiveness and safety of robotic-assisted versus laparoscopic hepatectomy for liver neoplasms: A meta-analysis of retrospective studies. Asian J Surg 2017; 41:401-416. [PMID: 28912048 DOI: 10.1016/j.asjsur.2017.07.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/30/2017] [Accepted: 07/25/2017] [Indexed: 02/07/2023] Open
Abstract
This meta-analysis aimed to investigate the effectiveness and safety of RAH and LLR for liver neoplasms. A systematic search was performed in PubMed, EMbase, the Cochrane Library, Web of science, and China Biology Medicine disc up to July 2016 for studies that provided comparisons between the surgical outcomes of RAH and LLR for liver neoplasms. WMD, OR and 95% CI were calculated and data combined using the random-effect model. The quality of the evidence was assessed using GRADE methods. A total of 17 studies were included in the meta-analysis, in which 487 patients were in the RAH group and 902 patients were in the LLR group. The meta-analysis results indicated: compared to LLR, RAH was associated with more estimated blood loss, longer operative time, and longer time to first nutritional intake (p < 0.05). There was no significant difference in length of hospital stay, conversion rate during operation, R0 resection rate, complications and mortality (p > 0.05). Three studies reported the total cost, and the result showed a higher cost in the RAH group when compared with the LLR group (p < 0.05). This meta-analysis indicated that RAH and LLR display similar effectiveness and safety in hepatectomy. Considering the lack of high quality original studies, prospective clinical trials should be conducted to provide strong evidence for clinical guidelines formation, and the insurance coverage policies should be established to promote the application of robotic surgery in the future.
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Affiliation(s)
- Lidong Hu
- Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou 730000, People's Republic of China; Department of General Surgery, Gansu Province People's Hospital, Lanzhou 730000, People's Republic of China
| | - Liang Yao
- Institution of Clinical Research and Evidence Based Medicine, Gansu Province People's Hospital, Lanzhou 730000, People's Republic of China
| | - Xiaofei Li
- Department of General Surgery, Gansu Province People's Hospital, Lanzhou 730000, People's Republic of China; Department of Clinical Medicine, Ningxia Medical University, Yinchuan 750004, People's Republic of China
| | - Penghui Jin
- Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou 730000, People's Republic of China; Department of General Surgery, Gansu Province People's Hospital, Lanzhou 730000, People's Republic of China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, People's Republic of China.
| | - Tiankang Guo
- Department of General Surgery, Gansu Province People's Hospital, Lanzhou 730000, People's Republic of China.
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Morise Z. Laparoscopic liver resection for posterosuperior tumors using caudal approach and postural changes: A new technical approach. World J Gastroenterol 2016; 22:10267-10274. [PMID: 28058008 PMCID: PMC5175240 DOI: 10.3748/wjg.v22.i47.10267] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 09/27/2016] [Accepted: 10/31/2016] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic liver resection (LLR) for tumors in the posterosuperior liver [segment (S) 7 and deep S6] is a challenging clinical procedure. This area is located in the bottom of the small subphrenic space (rib cage), with the large and heavy right liver on it when the patient is in the supine position. Thus, LLR of this area is technically demanding because of the handling of the right liver which is necessary to obtain a fine surgical view, secure hemostasis and conduct the resection so as to achieve an appropriate surgical margin in the cage. Handling of the right liver may be performed by the hand-assisted approach, robotic liver resection or by using spacers, such as a sterile glove pouch. In addition, the operative field of posterosuperior resection is in the deep bottom area of the subphrenic cage, with the liver S6 obstructing the laparoscopic caudal view of lesions. The use of intercostal ports facilitates the direct lateral approach into the cage and to the target area, with the combination of mobilization of the liver. Postural changes during the LLR procedure have also been reported to facilitate the LLR for this area, such as left lateral positioning for posterior sectionectomy and semi-prone positioning for tumors in the posterosuperior segments. In our hospital, LLR procedures for posterosuperior tumors are performed via the caudal approach with postural changes. The left lateral position is used for posterior sectionectomy and the semi-prone position is used for S7 segmentectomy and partial resections of S7 and deep S6 without combined intercostal ports insertion. Although the movement of instruments is restricted in the caudal approach, compared to the lateral approach, port placement in the para-vertebra area makes the manipulation feasible and stable, with minimum damage to the environment around the liver.
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Giulianotti PC, Bianco FM, Daskalaki D, Gonzalez-Ciccarelli LF, Kim J, Benedetti E. Robotic liver surgery: technical aspects and review of the literature. Hepatobiliary Surg Nutr 2016; 5:311-21. [PMID: 27500143 DOI: 10.21037/hbsn.2015.10.05] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Minimally invasive surgery for liver resections has a defined role and represents an accepted alternative to open techniques for selected cases. Robotic technology can overcome some of the disadvantages of the laparoscopic technique, mainly in the most complex cases. Precise dissection and microsuturing is possible, even in narrow operative fields, allowing for a better dissection of the hepatic hilum, fine lymphadenectomy, and biliary reconstruction even with small bile ducts and easier bleeding control. This technique has the potential to allow for a greater number of major resections and difficult segmentectomies to be performed in a minimally invasive fashion. The implementation of near-infrared fluorescence with indocyanine green (ICG) also allows for a more accurate recognition of vascular and biliary anatomy. The perspectives of this kind of virtually implemented imaging are very promising and may be reflected in better outcomes. The overall data present in current literature suggests that robotic liver resections are at least comparable to both open and laparoscopic surgery in terms of perioperative and postoperative outcomes. This article provides technical details of robotic liver resections and a review of the current literature.
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Affiliation(s)
- Pier Cristoforo Giulianotti
- Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL 60612, USA
| | - Francesco Maria Bianco
- Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL 60612, USA
| | - Despoina Daskalaki
- Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL 60612, USA
| | - Luis Fernando Gonzalez-Ciccarelli
- Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL 60612, USA
| | - Jihun Kim
- Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL 60612, USA
| | - Enrico Benedetti
- Division of Transplantation, Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL 60612, USA
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Ratti F, D'Alessandro V, Cipriani F, Giannone F, Catena M, Aldrighetti L. Influence of body habitus on feasibility and outcome of laparoscopic liver resections: a prospective study. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2016; 23:373-81. [DOI: 10.1002/jhbp.350] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 03/25/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Francesca Ratti
- Hepatobiliary Surgery Division; IRCCS San Raffaele Hospital; Milan Italy
| | | | - Federica Cipriani
- Hepatobiliary Surgery Division; IRCCS San Raffaele Hospital; Milan Italy
| | - Fabio Giannone
- Hepatobiliary Surgery Division; IRCCS San Raffaele Hospital; Milan Italy
| | - Marco Catena
- Hepatobiliary Surgery Division; IRCCS San Raffaele Hospital; Milan Italy
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division; IRCCS San Raffaele Hospital; Milan Italy
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Nota CL, Rinkes IHB, Molenaar IQ, van Santvoort HC, Fong Y, Hagendoorn J. Robot-assisted laparoscopic liver resection: a systematic review and pooled analysis of minor and major hepatectomies. HPB (Oxford) 2016; 18:113-120. [PMID: 26902129 PMCID: PMC4814602 DOI: 10.1016/j.hpb.2015.09.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 09/30/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Robotic surgery has been introduced to overcome the limitations of conventional laparoscopy. A systematic review and meta-analysis were performed to assess the safety and feasibility for three subgroups of robot-assisted laparoscopic liver resection: (i) minor resections of easily accessible segments: 2/3, 4B, 5, 6, (ii) minor resections of difficult located segments: 1, 4A, 7, 8 and (iii) major resections: ≥ 4 segments. METHODS A systematic search was performed in PubMed, EMBASE and Cochrane Library. RESULTS Twelve observational, mostly retrospective studies reporting on 363 patients were included. Data were pooled and analyzed. For subgroup (i) (n = 81) the weighted mean operative time was 215 ± 65 min. One conversion (1%) to laparotomy was needed. Weighted mean operative time for subgroup (ii) (n = 17) was 220 ± 60 min. No conversions were needed. For subgroup (iii) (n = 99) the weighted mean operative time was 405 ± 100 min. In this subgroup 8 robotic procedures (8%) were converted to open surgery. CONCLUSION Data show that robot-assisted laparoscopic liver resection is feasible in minor resections of all segments and major resections. Larger, prospective studies are warranted to compare the possible advantages of robot-assisted surgery with conventional laparoscopy and open surgery.
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Affiliation(s)
- Carolijn L Nota
- Department of Surgery, University Medical Center Utrecht, The Netherlands
| | | | - Izaak Q Molenaar
- Department of Surgery, University Medical Center Utrecht, The Netherlands
| | - Hjalmar C van Santvoort
- Department of Surgery, University Medical Center Utrecht, The Netherlands; Department of Surgery, St. Antonius Ziekenhuis Nieuwegein, The Netherlands
| | - Yuman Fong
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Jeroen Hagendoorn
- Department of Surgery, University Medical Center Utrecht, The Netherlands.
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Abstract
Operations on the liver have been undertaken for centuries for numerous indications including trauma, infections, and even for malignancy, but it was not until the past few decades that rates dramatically increased. This expanse in liver operations is due to a multitude of factors, including broader indications as well as improved safety. Our understanding of metastatic disease to the liver, especially colorectal cancer metastases, has vastly amplified the number of patients who would be candidates for hepatic resections and liver-directed therapies. We will focus our discussion here on planned minimally invasive operations for benign and malignant tumors as the majority of the literature relates to this setting.
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40
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Laparoscopic major hepatectomies: current trends and indications. A comparison with the open technique. Updates Surg 2015; 67:157-67. [DOI: 10.1007/s13304-015-0312-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 06/15/2015] [Indexed: 01/06/2023]
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