Multivisceral Resection in 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.

Download Full-text

ROBOTIC LIVER RESECTION. REPORT OF THE FIRST 50 CASES

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.202100000-92 ◽

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.

Download Full-text

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

Surgical Innovation ◽

10.1177/1553350620954580 ◽

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.

Download Full-text

Total Laparoscopic Resection of Hilar Cholangiocarcinoma Type 3b: Applying a Parachute Technique for Hepaticojejunostomy

Annals of Surgical Oncology ◽

10.1245/s10434-020-09175-1 ◽

2020 ◽

Author(s):

Robert Sucher ◽

Uwe Scheuermann ◽

Daniel Seehofer

Keyword(s):

Liver Resection ◽

Minimally Invasive ◽

Hilar Cholangiocarcinoma ◽

Laparoscopic Resection ◽

Invasive Procedure ◽

Perihilar Cholangiocarcinoma ◽

Minimally Invasive Techniques ◽

Minimally Invasive Procedure ◽

Transfusion Requirements ◽

Invasive Techniques

Abstract Background Laparoscopic liver resection for perihilar cholangiocarcinoma (pCCA) is still in its infancy. The biliary-enteric reconstruction represents one of the most delicate parts of this minimally invasive procedure. Methods In this study, a 78-year old woman with perihilar cholangiocarcinoma (pCCA) type 3b underwent a hepaticojejunostomy performed by a parachute technique. Results The operation, performed totally by minimally invasive resections, was completed in 386 min, with a blood loss of less than 400 ml and no transfusion requirements. Two intraluminal stents were placed during the hepaticojenunostomy for splinting of the biliary-enteric anastomosis. The patient required prolonged antibiotic treatment for postoperative cholangitis and finally was discharged on postoperative day 15. The histopathologic grading displayed a G 2–3 adenocarcinoma, pT3 pN0, M0, L1, V1, pN1, UICC IIIc R0, and the patient was referred to adjuvant chemotherapy. Conclusion Resections of pCCAs, performed totally by minimally invasive techniques, may be feasible and safe for a selected group of patients. With this approach, a running-suture hepaticojejunostomy using the parachute technique represents a worthwhile strategy for biliary-enteric reconstruction.

Download Full-text

Impact of Enhanced Recovery After Surgery (ERAS) approach and minimally-invasive techniques on outcome of patients undergoing liver surgery for hepatocellular carcinoma. A comparative study from a single institution

Clinical Nutrition ESPEN ◽

10.1016/j.clnesp.2016.02.036 ◽

2016 ◽

Vol 12 ◽

pp. e41 ◽

Cited By ~ 2

Author(s):

Francesca Ratti ◽

Federica Cipriani ◽

Raffaella Reineke ◽

Marco Catena ◽

Laura Comotti ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Minimally Invasive ◽

Comparative Study ◽

Liver Surgery ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Minimally Invasive Techniques ◽

Single Institution ◽

Invasive Techniques

Download Full-text

Improving Outcomes Defending Patient Safety: The Learning Journey in Robotic Liver Resections

BioMed Research International ◽

10.1155/2019/1835085 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8 ◽

Cited By ~ 7

Author(s):

Paolo Magistri ◽

Gian Piero Guerrini ◽

Roberto Ballarin ◽

Giacomo Assirati ◽

Giuseppe Tarantino ◽

...

Keyword(s):

Liver Resection ◽

Learning Curve ◽

Operative Time ◽

Short Term ◽

Robotic Liver Resection ◽

Referral Center ◽

Learning Journey ◽

Secondary Liver Neoplasms ◽

Time Of Operation ◽

Robotic Liver Surgery

Background. While laparoscopy is currently adopted for hepatic resections, robotic approaches to the liver have not gained wide acceptance. We decided to analyze the learning curve in the field of robotic liver surgery comparing short-term outcomes between the first and the second half of our series. Methods. We retrospectively reviewed demographics and clinical data of patients who underwent robotic liver resection at our institution from July 2014 through September 2017. 60 patients diagnosed with primary or secondary liver neoplasms or hydatid disease were included in this study. ASA PS >3, heart failure, respiratory insufficiency, and general contraindication to pneumoperitoneum were exclusion criteria. Results. 60 patients were included. We observed a statistically significant decrease in operative time (p<0.001), intraoperative blood loss (p=0.01), and postoperative complications (p<0.001) after 30 cases. From the interpretation of the CUSUM curve, the time of operation appears to be significantly reduced after the first 30 operations. Discussion. This is the first European analysis of the learning curve for robotic liver resection in an HPB and liver transplant referral center. However, more studies are needed to confirm such results outside a HPB referral center. This is crucial to develop formal credentialing protocols for both junior and senior surgeons.

Download Full-text

Laparoscopic transthoracic liver resection

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/s0102-67202014000400014 ◽

2014 ◽

Vol 27 (4) ◽

pp. 288-290 ◽

Cited By ~ 5

Author(s):

Jaime Arthur Pirola KRÜGER ◽

Fabrício Ferreira COELHO ◽

Marcos Vinícius PERINI ◽

Paulo HERMAN

Keyword(s):

Liver Resection ◽

Minimally Invasive ◽

Liver Surgery ◽

Wedge Resection ◽

The Other ◽

Laparoscopic Liver Surgery ◽

Transthoracic Approach ◽

Technical Description ◽

Abdominal Interventions ◽

Segment 8

INTRODUCTION: Minimally invasive laparoscopic liver surgery is being performed with increased frequency. Lesions located on the anterior and lateral liver segments are easier to approach through laparoscopy. On the other hand, laparoscopic access to posterior and superior segments is less frequent and technically demanding. AIM: Technical description for laparoscopic transthoracic access employed on hepatic wedge resection. TECHNIQUE: Laparoscopic transthoracic hepatic wedge resection on segment 8. CONCLUSION: Transthoracic approach allows access to the posterior and superior segments of the liver, and should be considered for oddly located tumors and in patients with numerous previous abdominal interventions.

Download Full-text