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: Salem I Noureldine[Show abstract] [Hide abstract]
ABSTRACT: Robotic-assisted surgery offers a solution to fundamental limitations of conventional laparoscopic surgery, and its use is gaining wide popularity. However, the application of this technology has yet to be established in hepatic surgery. A retrospective analysis of our prospectively collected liver surgery database was performed. Over a 6-month period, all consecutive patients who underwent robotic-assisted hepatic resection for a liver neoplasm were included. Demographics, operative time, and morbidity encountered were evaluated. A total of 7 robotic-assisted liver resections were performed, including 2 robotic-assisted single-port access liver resections with the da Vinci-Si Surgical System (Intuitive Surgical Sunnyvalle, Calif.) USA. The mean age was 44.6 years (range, 21-68 years); there were 5 male and 2 female patients. The mean operative time (± SD) was 61.4 ± 26.7 minutes; the mean operative console time (± SD) was 38.2 ± 23 minutes. No conversions were required. The mean blood loss was 100.7 mL (range, 10-200 mL). The mean hospital stay (± SD) was 2 ± 0.4 days. No postoperative morbidity related to the procedure or death was encountered. Our initial experience with robotic liver resection confirms that this technique is both feasible and safe. Robotic-assisted technology appears to improve the precision and ergonomics of single-access surgery while preserving the known benefits of laparoscopic surgery, including cosmesis, minimal morbidity, and faster recovery.JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons 01/2013; 17(1):56-62. DOI:10.4293/108680812X13517013317671 · 0.79 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Laparoscopic liver resection has been performed in a limited number of centers, but worldwide the adoption and worldwide progress of the procedure have been slow since the 1990s, mainly because of the difficulty of controlling the hemorrhage during dissection of the hepatic parenchyma. In the late 2000s, technological innovations, improvement in surgical technique, and surgeons' accumulation of experience have led to more rapid progress of laparoscopic liver resection. Now, laparoscopic liver resection is able to be done by several approaches, for all locations of the tumors, for several diseases, with several types of resection, not only for tumors but for liver transplantation, with equivalent or better results compared with open surgery. Laparoscopic liver resection has been a standard procedure for left lateral sectionectomy or peripheral resection of the anterior liver, and other types of laparoscopic liver resection are expected to be standard in the near future.Clinical Journal of Gastroenterology 02/2013; 6(1). DOI:10.1007/s12328-012-0352-z
- [Show abstract] [Hide abstract]
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.Journal of Hepato-Biliary-Pancreatic Sciences 09/2012; 20(2). DOI:10.1007/s00534-012-0560-4 · 2.31 Impact Factor