Robot-assisted laparoscopic hemi-hepatectomy: Technique and surgical outcomes

Department of Surgery, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong SAR, China.
International Journal of Surgery (London, England) (Impact Factor: 1.53). 11/2011; 10(1):11-5. DOI: 10.1016/j.ijsu.2011.10.005
Source: PubMed


Laparoscopic major hepatectomies remain a challenge for liver surgeons. The recent introduction of robotic surgical systems has revolutionized the field of minimally invasive surgery. It was developed to overcome the disadvantages of conventional laparoscopic surgery. The use of robotic system in laparoscopic major hepatectomy was not known yet.
Between December 2010 and July 2011, 6 right hemi-hepatectomies and 4 left hemi-hepatectomies were performed by robot-assisted laparoscopic approach. Prospectively collected data was analyzed retrospectively.
Overall mean duration of the operation was 347.4 ± 85.9 (SD) minutes. Mean duration of the operation for right hemi-hepatectomy was 364.8 ± 98.1 ml, while mean duration of the operation for left hemi-hepatectomy was 321.3 ± 67.8 ml. Overall mean operative blood loss was 407 ± 286.8 ml. Mean operative blood loss for right hemi-hepatectomy was 500 ± 303.3 ml, while mean operative blood loss for left hemi-hepatectomy was 156.9 ± 40.7 ml. No open conversion was needed. Three patients (30%) had postoperative complications. There was no mortality. Mean hospital stay was 6.7 ± 3.5 days.
Our series indicate that in experienced hands, robot-assisted laparoscopic approach for hemi-hepatectomy is feasible and safe. As experience grows, this procedure will be more common.

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    • "Mean intraoperative blood loss ranged from 50 to 660 mL. There was a tendency for patients to experience more blood loss during hepatectomies or combined colorectal surgeries [12, 15, 17]. No difference in blood loss was noted between robotic and laparoscopic surgeries in the series reported by Berber et al., whereas in the study by Ji et al. less blood loss was reported during robotic procedures than during laparoscopic and open resection procedures. "
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    ABSTRACT: Background Robotic liver resection has emerged as a new modality in the field of minimally invasive surgery. However, the effectiveness of this approach for liver resection is not yet known. Methods A literature survey was performed using specific search phrases in PubMed. Case series that focused on biliary reconstruction were excluded. Characteristics, such as patient demographics, perioperative outcomes, and oncological results for colorectal liver metastasis and hepatocellular carcinoma were analyzed. Results Nineteen series that described the cases of 217 eligible patients were reviewed. The most commonly performed procedures were wedge resection and segmentectomy. Right hepatectomy was performed in a few specialized centers. The conversion and complication rates were 4.6 and 20.3 %, respectively. The most common reason for conversion was unclear tumor margin. Intra-abdominal fluid collection was the most frequently occurring morbidity. Mean operation time was 200–507 min. Mean intraoperative blood loss was 50–660 mL, with a tendency toward increased blood loss observed in series that included major hepatectomies. Mean postoperative hospital stay was 5.5–11.7 days. The longest mean follow-up time was 36 months for colorectal liver metastasis and 25.1 months in hepatocellular carcinoma. Disease-free survival for mixed malignancies was comparable to that after laparoscopic procedures. Overall survival was not reported. Conclusions Robotic liver resection is safe and feasible for experienced surgeons with advanced laparoscopic skills. Long-term oncologic outcomes are unclear, but short-term perioperative results seem comparable to those of conventional laparoscopic liver resection.
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    ABSTRACT: Minimally invasive liver surgery has recently undergone an explosion in reported worldwide experience. Given its comparable outcomes to its open counterpart, high-volume centers are utilizing minimal access liver surgery more frequently under well-defined criteria. The recent introduction of robot-assisted surgery has further revolutionized the field of minimally invasive surgery and has expanded the reach of feasibility. Robot-assisted surgery was developed to help overcome the disadvantages of conventional laparoscopic surgery. As a result, there has been an increase in the reporting of advanced robot-assisted liver resections. A literature review was performed to identify the current manuscripts describing robot-assisted liver surgery. Nine case series were identified, yielding 144 unique patient characteristics. Outcomes indicate that robot-assisted liver resection is feasible and safe for both minor and major liver resections with regard to estimated blood loss, length of stay, and complications. Early data also suggest that robot-assisted liver surgery is efficacious with regard to short-term oncologic outcomes. Future studies will be needed to better evaluate advantages and disadvantages compared to laparoscopic liver resections.
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