scholarly journals ROBOTIC LIVER RESECTION. REPORT OF THE FIRST 50 CASES

2021 ◽  
Vol 58 (4) ◽  
pp. 514-519
Author(s):  
Marcel Autran C MACHADO ◽  
Murillo M LOBO-FILHO ◽  
Bruno H MATTOS ◽  
André O ARDENGH ◽  
Fábio F MAKDISSI
Keyword(s):  
Liver Resection ◽  
Minimally Invasive ◽  
Colon Resection ◽  
Consensus Conference ◽  
Invasive Technique ◽  
Open Resection ◽  
Robotic Liver Resection ◽  
Robotic Hepatectomy ◽  
Liver Resections ◽  
Practical Guidelines

ABSTRACT BACKGROUND: Robotic surgery has gained growing acceptance in recent years, expanding to liver resection. OBJECTIVE: The aim of this paper is to report the experience with our first fifty robotic liver resections. METHODS: This was a single-cohort, retrospective study. From May 2018 to December 2020, 50 consecutive patients underwent robotic liver resection in a single center. All patients with indication for minimally invasive liver resection underwent robotic hepatectomy. The indication for the use of minimally invasive technique followed practical guidelines based on the second international laparoscopic liver consensus conference. RESULTS: The proportion of robotic liver resection was 58.8% of all liver resections. Thirty women and 20 men with median age of 61 years underwent robotic liver resection. Forty-two patients were operated on for malignant diseases. Major liver resection was performed in 16 (32%) patients. Intrahepatic Glissonian approach was used in 28 patients for anatomical resection. In sixteen patients, the robotic liver resection was a redo hepatectomy. In 10 patients, previous liver resection was an open resection and in six it was minimally invasive resection. Simultaneous colon resection was done in three patients. One patient was converted to open resection. Two patients received blood transfusion. Four (8%) patients presented postoperative complications. No 90-day mortality was observed. CONCLUSION: The use of the robot for liver surgery allowed to perform increasingly difficult procedures with similar outcomes of less difficult liver resections.

scholarly journals Multivisceral Resection in Robotic Liver Surgery

Cancers ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 355
Author(s):  
Kevin M. Sullivan ◽  
Yuman Fong
Keyword(s):  
Liver Resection ◽  
Minimally Invasive ◽  
Liver Surgery ◽  
3D Visualization ◽  
Multivisceral Resection ◽  
Robotic Liver Resection ◽  
Conversion To Open Surgery ◽  
Liver Resections ◽  
Invasive Techniques ◽  
Robotic Liver Surgery

Minimally invasive surgery techniques are expanding in utilization in liver resections and now include robotic approaches. Robotic liver resection has been demonstrated to have several benefits, including surgeon ergonomics, wrist articulation, and 3D visualization. Similarly, for multivisceral liver resections, the use of minimally invasive techniques has evolved and expanded from laparoscopy to robotics. The aim of this article is to review the literature and describe multivisceral resections, including hepatectomy, using a robotic technique. We describe over 50 published cases of simultaneous robotic liver resection with colon or rectal resection. In addition, we describe several pancreatectomies performed with liver resection and one extra-abdominal pulmonary resection with liver resection. In total, these select reported cases at experienced centers demonstrate the safety of robotic multivisceral resection in liver surgery with acceptable morbidity and rare conversion to open surgery. As robotic technology advances and experience with robotic techniques grows, robotic multivisceral resection in liver surgery should continue to be investigated in future studies.

Transitioning From Open to Robotic Liver Resection. Results of 46 Consecutive Procedures Including a Majority of Major Hepatectomies

2020 ◽  
pp. 155335062095458
Author(s):  
Alain Valverde ◽  
Solafah Abdallah ◽  
Divya Danoussou ◽  
Nicolas Goasguen ◽  
Ingrid Jouvin ◽  
...  
Keyword(s):  
Liver Resection ◽  
Intraoperative Complications ◽  
Robotic Assisted ◽  
Robotic Liver Resection ◽  
Liver Resections ◽  
Hospital Patients ◽  
Minimally Invasive Liver Resection ◽  
Malignant Liver ◽  
Major Hepatectomies

Aims. Minimally invasive liver resection is a complex and challenging operation. Although authors have reported robotic liver resection shows improved safety and efficacy compared with open liver resection, robotic major liver resections for malignant liver lesions treatment remain inadequately evaluated. The aims of the present study were to evaluate the feasibility and safety of transitioning from open to robotic liver resection in a nonuniversity hospital. Patients and Methods. From December 2015 to March 2020, 46 patients underwent totally robotic-assisted liver resections out of 446 robotic procedures. Also, we retrospectively reviewed the last 27 open right hepatectomies (ORHs) and compared then with the first 25 anatomic robotic-assisted right hepatectomies (RRHs). Results. Mean operative time, mean blood lost, rate of complications, and mean hospital stay were associated with the complexity of the procedure. The comparison between ORH and RRH showed that intraoperative complications were less frequently observed during ORH whereas RRH showed a trend in favor of less blood loss. ORH had a trend toward smaller surgical margins and higher rate of R1 resections. Recurrence occurred in 31 (59%) patients and was more frequently observed after ORH. However, the mean follow-up was significantly shorter after RRH. Conclusion. Our study demonstrated the technical feasibility and safety of transitioning from open to robotic liver resection (including major hepatectomies) in a nonuniversity setting. Higher costs remain an important drawback for robotic surgery.

scholarly journals Short-term results after minimally invasive and open liver resection for liver metastases of colorectal cancer: a single center experience

2018 ◽  
Vol 46 (6) ◽  
pp. 584-591
Author(s):  
M. G. Efanov ◽  
R. B. Alikhanov ◽  
V. V. Tsvirkun ◽  
I. V. Kazakov ◽  
P. P. Kim ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Liver Resection ◽  
Minimally Invasive ◽  
Liver Metastases ◽  
Surgical Margin ◽  
Colorectal Metastases ◽  
Single Center ◽  
Open Resection ◽  
Tumor Spread ◽  
Primary Tumors

Rationale: Until now, safety of minimally invasive liver resection (MILR) has not been studied sufficiently.Aim: To assess immediate results of MILR and open type resections in patients with colorectal metastases, performed in the Russian center of surgical hepatology specialized at implementation of minimally invasive techniques.Materials and мethods: This was a retrospective observational case-control study. Patients who underwent surgery for isolated liver metastases of colorectal cancer in a  single center from October 2013 to February 2018 were included into the study.Results: As per December 2017, over 500 resections have been performed in the study center, including 226 MILR. One hundred two patients underwent open resection and MILR for colorectal metastases. From 83 patients enrolled into the study, 51 (61%) had MILR, including 7 robotic MILR. The open resection and MILR groups did not differ in terms of gender, age, ASA score, primary tumors location and stage by the time of primary intervention. There were no between-group differences for factors that determine the tumor spread and influence the resection problems, i.e. the difficulty index of MILR, rate of anatomic resection, resection of complex segments, vascular involvement, size and number of metastases, multiple liver lesions and bilobar metastases. No difference was found for immediate outcomes in terms of frequency of the free surgical margin > 2 mm, rate of the Pringle maneuver implementation, duration of the procedure, blood components transfusion, severe complications (Clavien-Dindo Grade > II), and time in intensive care unit. Compared to open procedures, MILR were associated with significantly less blood loss: 583 (50–3000) mL vs. 308 (0–3300) mL (p = 0.012), respectively, and shorter duration of hospital stay: 10 (4–29) days vs. 9 (4–29) days (р < 0.001), respectively.Conclusion: In a specialized surgical hepatology center, MILR can be performed equally to complex open procedures without changes in the rates and types of complications, but with an improvement of immediate outcomes.

scholarly journals Robotic Liver Resection Versus Percutaneous Ablation for Early HCC: Short- and Long-Term Results

Cancers ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3578
Author(s):  
Paolo Magistri ◽  
Barbara Catellani ◽  
Samuele Frassoni ◽  
Cristiano Guidetti ◽  
Tiziana Olivieri ◽  
...  
Keyword(s):  
Liver Resection ◽  
Minimally Invasive ◽  
High Volume ◽  
Long Term Results ◽  
Percutaneous Ablation ◽  
Newly Diagnosed ◽  
Extensive Experience ◽  
Robotic Liver Resection ◽  
Short And Long Term

Background: The correct approach for early hepatocellular carcinoma (HCC) is debatable, since multiple options are currently available. Percutaneous ablation (PA) is associated in some series to reduced morbidity compared to liver resection (LR); therefore, minimally invasive surgery may play a significant role in this setting. Methods: All consecutive patients treated by robotic liver resection (RLR) or PA between January 2014 and October 2019 for a newly diagnosed single HCC, less than 3 cm in size (very early/early stages according to the Barcelona Clinic Liver Cancer (BCLC)) on chronic liver disease or liver cirrhosis, were enrolled in this retrospective study. The aim of this study was to compare short- and long-term outcomes to define the best approach in this specific cohort. Results: 60 patients fulfilled the inclusion criteria: 24 RLR and 36 PA. The two populations were homogeneous in terms of baseline characteristics. There were no statistically significant differences regarding the incidence of postoperative morbidity (RLR 38% vs. PA 19%, p = 0.15). The cumulative incidence of recurrence (CIR) was significantly higher in patients who underwent PA, with the one, two, and three years of CIR being 42%, 69%, and 73% in the PA group and 17%, 27%, and 27% in the RLR group, respectively. Conclusions: RLR provides a significantly higher potential of cure and tumor-related free survival in cases of newly diagnosed single HCCs smaller than 3 cm. Therefore, it can be considered as a first-line approach for the treatment of patients with those characteristics in high-volume centers with extensive experience in the field of hepatobiliary surgery and minimally invasive approaches.

scholarly journals Robotic hepatectomy and biliary reconstruction for perihilar cholangiocarcinoma: a pioneer western case series

2021 ◽  
Author(s):  
Umberto Cillo ◽  
Francesco Enrico D’Amico ◽  
Alessandro Furlanetto ◽  
Luca Perin ◽  
Enrico Gringeri
Keyword(s):  
Minimally Invasive ◽  
Open Surgery ◽  
Da Vinci ◽  
Video Clip ◽  
Operating Time ◽  
Perihilar Cholangiocarcinoma ◽  
Invasive Technique ◽  
Biliary Reconstruction ◽  
Robot Assisted ◽  
Liver Resections

AbstractOpen surgery is the standard of care for perihilar cholangiocarcinoma (pCCA). With the aim of oncologic radicality, it requires a complex major hepatectomy with biliary reconstruction. The postoperative course is consequently often complicated, with severe morbidity and mortality rates of up to 27.5–54% and 18%, respectively. Robotic liver surgery is emerging as a safe, minimally-invasive technique with huge potential for pCCA management. After the first case described by Giulianotti in 2010, here we present the first western series of robot-assisted liver resections with biliary reconstruction for pCCA with the aim to preliminarily assess the feasibility and repeatability of the procedure. At our high-volume teaching hospital center dedicated to HPB surgery, 128 pCCA patients have been surgically treated in the last 15 years whereas more than 800 laparoscopic liver resections have been performed. Since the Da Vinci Xi Robotic platform was introduced in late 2018, 6 major robotic liver resections with biliary reconstruction have been performed, 4 of which were for pCCA. All 4 cases involved a left hepatectomy with caudate lobectomy. The median operating time was 840 min, with a median blood loss of 700 ml. One case was converted to open surgery during the reconstruction due to a short mesentery preventing the hepatico-jejunostomy. None of the patients experienced major complications, while minor complications occurred in 3 out of 4 cases. One biliary leak was managed conservatively. The median postoperative stay was 9 days. Negative biliary margins were achieved in 3 of the 4 cases. An included video clip shows the most relevant technical details. This preliminary series demonstrates that robot-assisted liver resection for pCCA is feasible. We speculate that the da Vinci platform has a relevant potential in pCCA surgery with particular reference to the multi-duct biliary reconstruction. Further studies are needed to better clarify the role of this high-cost technology in the minimally-invasive treatment of pCCA.

A novel microwave tool for robotic liver resection in minimally invasive surgery

2020 ◽  
pp. 1-8
Author(s):  
Margherita Brancadoro ◽  
Mattia Dimitri ◽  
Mohamed Nassim Boushaki ◽  
Fabio Staderini ◽  
Edoardo Sinibaldi ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Liver Resection ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Robotic Liver Resection

Hospitalization Costs and Outcomes of Open, Laparoscopic, and Robotic Liver Resections

2021 ◽  
pp. 000313482110110
Author(s):  
Hassan Aziz ◽  
Kamil Hanna ◽  
Nassim Lashkari ◽  
Noor-Us-Sabah Ahmad ◽  
Yuri Genyk ◽  
...  
Keyword(s):  
Liver Resection ◽  
Laparoscopic Approach ◽  
Cost Effective ◽  
The United States ◽  
Hospital Length Of Stay ◽  
Financial Benefit ◽  
Readmission Rates ◽  
Robotic Hepatectomy ◽  
Liver Resections ◽  
Hospitalization Costs

Introduction Most liver resections performed in the United States are open. With the ever-increasing role of robotic surgery, our study's role is to assess national outcomes based on the surgical approach. Methods We performed a retrospective analysis of the 2015 National Readmission Database (NRD). We selected patients undergoing open, laparoscopic, and robotic hepatectomy. Propensity score matching was performed to match the three groups in terms of demographics, hospital characteristics, and resection type. Our primary outcome was 6-month readmission rates and associated costs. Results 3,872 patients were included in the analysis (open = 3,420, laparoscopic = 343, and robotic = 109). Robotic liver resection has lower 6-month readmission rates (18.3%) than the laparoscopic (26.7%) and open (30%) counterparts. The robotic approach was more cost-effective ($127,716.56 ± 12,567.31) than the open ($157,880.82 ± 18,560.2) and laparoscopic approach ($152,060.78 ± 8,890.13) in terms of the total cost which includes cost per readmission. Conclusions There is a financial benefit of using robotics in terms of cost, hospital length of stay, and readmission rates in patients undergoing liver resection, cost.

scholarly journals Practical guidelines for performing laparoscopic liver resection based on the second international laparoscopic liver consensus conference

2018 ◽  
Vol 27 (1) ◽  
pp. A5-A9 ◽  
Author(s):  
Jai Young Cho ◽  
Ho-Seong Han ◽  
Go Wakabayashi ◽  
Olivier Soubrane ◽  
David Geller ◽  
...  
Keyword(s):  
Liver Resection ◽  
Laparoscopic Liver Resection ◽  
Consensus Conference ◽  
Practical Guidelines ◽  
Second International

scholarly journals IWATE criteria are associated with perioperative outcomes in robotic hepatectomy: a retrospective review of 225 resections

2021 ◽  
Author(s):  
Kevin P. Labadie ◽  
David J. Droullard ◽  
Alex W. Lois ◽  
Sara K. Daniel ◽  
Kathryn E. McNevin ◽  
...  
Keyword(s):  
Linear Regression ◽  
Minimally Invasive ◽  
Linear Regression Analysis ◽  
Oncologic Outcomes ◽  
Perioperative Outcomes ◽  
Difficulty Level ◽  
Multivariable Model ◽  
Robotic Hepatectomy ◽  
Liver Resections ◽  
Minimally Invasive Hepatectomy

Abstract Background Robotic hepatectomy (RH) is increasingly utilized for minor and major liver resections. The IWATE criteria were developed to classify minimally invasive liver resections by difficulty. The objective of this study was to apply the IWATE criteria in RH and to describe perioperative and oncologic outcomes of RH over the last decade at our institution. Methods Perioperative and oncologic outcomes of patients who underwent RH between 2011 and 2019 were retrospectively collected. The difficulty level of each operation was assessed using the IWATE criteria, and outcomes were compared at each level. Univariate linear regression was performed to characterize the relationship between IWATE criteria and perioperative outcomes (OR time, EBL, and LOS), and a multivariable model was also developed to address potential confounding by patient characteristics (age, sex, BMI, prior abdominal surgery, ASA class, and simultaneous non-hepatectomy operation). Results Two hundred and twenty-five RH were performed. Median IWATE criteria for RH were 6 (IQR 5–9), with low, intermediate, advanced, and expert resections accounting for 23% (n = 51), 34% (n = 77), 32% (n = 72), and 11% (n = 25) of resections, respectively. The majority of resections were parenchymal-sparing approaches, including anatomic segmentectomies and non-anatomic partial resections. 30-day complication rate was 14%, conversion to open surgery occurred in 9 patients (4%), and there were no deaths within 30 days postoperatively. In the univariate linear regression analysis, IWATE criteria were positively associated with OR time, EBL, and LOS. In the multivariable model, IWATE criteria were independently associated with greater OR time, EBL, and LOS. Two-year overall survival for hepatocellular carcinoma and intrahepatic cholangiocarcinoma was 94% and 50%, respectively. Conclusion In conclusion, the IWATE criteria are associated with surgical outcomes after RH. This series highlights the utility of RH for difficult hepatic resections, particularly parenchymal-sparing resections in the posterosuperior sector, extending the indication of minimally invasive hepatectomy in experienced hands and potentially offering select patients an alternative to open hepatectomy or other less definitive liver-directed treatment options.

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