Robot-assisted laparoscopic hemi-hepatectomy: technique and surgical outcomes.
ABSTRACT 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.
- SourceAvailable from: Go Wakabayashi[show abstract] [hide abstract]
ABSTRACT: OBJECTIVE:: This review assesses the current status of laparoscopic liver resection. BACKGROUND:: The trend in laparoscopic liver resection has been moving from limited resections toward major hepatectomy. The surgical techniques for laparoscopic major hepatectomy include pure laparoscopic, hand-assisted laparoscopic, and laparoscopy-assisted methods. We performed a literature search and systematic review to assess the current status of laparoscopic major hepatectomy. METHODS:: Our literature review was conducted in Medline using the keywords "laparoscopy" or "laparoscopic" combined with "liver resection" or "hepatectomy." Articles written in English containing more than 10 cases of laparoscopic major hepatectomy were selected. RESULTS AND CONCLUSIONS:: Twenty-nine articles were selected for this review. The laparoscopic major hepatectomies achieved similar patient and economic outcomes compared with open liver resections in selected (noncirrhotic) patients. Surgeon experience with the techniques affected the results; thus, a learning period is mandatory. Of these 3 techniques, the pure laparoscopic method is suitable for experienced surgeons to achieve better cosmetic outcomes, whereas the hand-assisted laparoscopic method was associated with better perioperative outcomes; the laparoscopy-assisted method is used by surgeons for unique resections such as resection of cirrhotic livers, laparoscopic resection of tumors in unfavorable locations, and living donor hepatectomies. In addition, the laparoscopic major hepatectomy-specific, long-term oncologic outcomes remain to be addressed in future publications.Annals of surgery 12/2012; · 7.90 Impact Factor
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ABSTRACT: Robotic liver resection is a new promising minimally invasive surgical technique not yet validated by level I evidence. During recent years, the application of the laparoscopic approach to liver resection has grown less than other abdominal specialties due to the intrinsic limitations of laparoscopic instruments. Robotics can overcome these limitations above all for complex operations. A review of the literature on major hepatic surgery was conducted on PubMed using selected keywords. Two hundred and thirty-five patients in 17 series were analysed and outcomes such as operative time, estimated blood loss, length of hospital stay, complications, conversion rate, and costs were described. The most commonly performed procedures were wedge resection and segmentectomy, but the predominance of major hepatectomies performed with robotic surgery is likely due to the superior control achieved by the robotic system. The conversion and complication rates were 4.2% and 13.4%, respectively. Intracavitary fluid collections and bile leaks were the most frequently occurring morbidities. The mean operation time was 285 min. The mean intraoperative blood loss was 50-280 mL. The mean postoperative hospital stay was four to seven days. Overall survival and long-term outcomes were not reported. Robotic liver surgery in Italy has become a clinical reality that is gaining increasing acceptance; a survey was carried out on robotic surgery, which showed that it is perceived as a significant advantage for operators and a consistent gain for the patient. More than 100 robotic hepatic resections have been performed in Italy where important robotic training schools are active. Robotic liver surgery is feasible and safe in trained and experienced hands. Further evaluation is required to assess the improvement in outcomes and long-term oncologic follow-up.ecancermedicalscience 01/2013; 7:358.
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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.Surgical Endoscopy 12/2012; · 3.43 Impact Factor