scholarly journals Three-Device (3D) Technique for Liver Parenchyma Dissection in Robotic Liver Surgery

2021 ◽  
Vol 10 (22) ◽  
pp. 5265
Author(s):  
Aristotelis Perrakis ◽  
Mirhasan Rahimli ◽  
Andrew A. Gumbs ◽  
Victor Negrini ◽  
Mihailo Andric ◽  
...  
Keyword(s):  
Liver Surgery ◽  
Liver Parenchyma ◽  
R0 Resection ◽  
Parenchymal Transection ◽  
Minimally Invasive Liver Surgery ◽  
Robotic Hepatectomy ◽  
Liver Resections ◽  
New Strategy ◽  
Laparoscopic Techniques ◽  
Robotic Liver Surgery

Background: The implementation of robotics in liver surgery offers several advantages compared to conventional open and laparoscopic techniques. One major advantage is the enhanced degree of freedom at the tip of the robotic tools compared to laparoscopic instruments. This enables excellent vessel control during inflow and outflow dissection of the liver. Parenchymal transection remains the most challenging part during robotic liver resection because currently available robotic instruments for parenchymal transection have several limitations and there is no standardized technique as of yet. We established a new strategy and share our experience. Methods: We present a novel technique for the transection of liver parenchyma during robotic surgery, using three devices (3D) simultaneously: monopolar scissors and bipolar Maryland forceps of the robot and laparoscopic-guided waterjet. We collected the perioperative data of twenty-eight patients who underwent this procedure for minor and major liver resections between February 2019 and December 2020 from the Magdeburg Registry of minimally invasive liver surgery (MD-MILS). Results: Twenty-eight patients underwent robotic-assisted 3D parenchyma dissection within the investigation period. Twelve cases of major and sixteen cases of minor hepatectomy for malignant and non-malignant cases were performed. Operative time for major liver resections (≥ 3 liver segments) was 381.7 (SD 80.6) min vs. 252.0 (70.4) min for minor resections (p < 0.01). Intraoperative measured blood loss was 495.8 (SD 508.8) ml for major and 256.3 (170.2) ml for minor liver resections (p = 0.090). The mean postoperative stay was 13.3 (SD 11.1) days for all cases. Liver surgery-related morbidity was 10.7%, no mortalities occurred. We achieved an R0 resection in all malignant cases. Conclusions: The 3D technique for parenchyma dissection in robotic liver surgery is a safe and feasible procedure. This novel method offers an advanced locally controlled preparation of intrahepatic vessels and bile ducts. The combination of precise extrahepatic vessel handling with the 3D technique of parenchyma dissection is a fundamental step forward to the standardization of robotic liver surgery for teaching purposing and the wider adoption of robotic hepatectomy into routine patient care.

scholarly journals Segment-oriented liver resections based on posterior intrahepatic glissonian approach

2012 ◽  
Vol 59 (3) ◽  
pp. 41-48 ◽  
Author(s):  
Krstina Doklestic ◽  
Vladimir Djukic ◽  
Vesna Bumbasirevic ◽  
Bojan Jovanovic ◽  
Aleksandar Karamarkovic
Keyword(s):  
Liver Tumors ◽  
Vascular Occlusion ◽  
Liver Parenchyma ◽  
R0 Resection ◽  
Liver Resections ◽  
Glissonian Approach ◽  
Glissonean Pedicle ◽  
Tumor Clearance ◽  
Parenchyma Sparing ◽  
Vascular Stapler

Background: Segment-oriented liver resections can be performed effective by posterior intrahepatic approach. A significance of such resection is that they are oncologically radical as well as parenchyma- sparing. Methodology: Segmental liver resections were performed in 102 patients with liver tumors. Suprahilar control of the appropriate glissonean pedicle was achieved by the posterior intrahepatic approach. Liver parenchyma was transsected by ultrasonic dissector, under intermittent vascular occlusion (IVO). Pedicle was divided at the end of resection using "endo-GIA" vascular stapler. Results: The overall transection time was 30,14+12,56 min. The amount of blood loss was 285,59+129,92 ml. The postoperative complication rate was 25,49%. R0 resection had 94 (92,16%) patients. There was no liver failure or perioperative death. Conclusions: Posterior intrahepatic approach for segmental resection is safe, can expedite the liver transection and reduce intraoperative hemorrhage. This approach provides adequate tumor clearance with preservation of normal parenchyma, as well as the vasculature or the biliary drainage of the contralateral liver.

scholarly journals Robotic and laparoscopic liver resection—comparative experiences at a high-volume German academic center

2021 ◽  
Author(s):  
E. Lorenz ◽  
J. Arend ◽  
M. Franz ◽  
M. Rahimli ◽  
A. Perrakis ◽  
...  
Keyword(s):  
Liver Resection ◽  
Minimally Invasive ◽  
Liver Surgery ◽  
Laparoscopic Liver Resection ◽  
Malignant Tumors ◽  
Statistical Significance ◽  
R0 Resection ◽  
Tumor Diameter ◽  
Safe Procedure ◽  
Minimally Invasive Liver Surgery

Abstract Purpose Minimally invasive liver surgery (MILS) is a feasible and safe procedure for benign and malignant tumors. There has been an ongoing debate on whether conventional laparoscopic liver resection (LLR) or robotic liver resection (RLR) is superior and if one approach should be favored over the other. We started using LLR in 2010, and introduced RLR in 2013. In the present paper, we report on our experiences with these two techniques as early adopters in Germany. Methods The data of patients who underwent MILS between 2010 and 2020 were collected prospectively in the Magdeburg Registry for Minimally Invasive Liver Surgery (MD-MILS). A retrospective analysis was performed regarding patient demographics, tumor characteristics, and perioperative parameters. Results We identified 155 patients fulfilling the inclusion criteria. Of these, 111 (71.6%) underwent LLR and 44 (29.4%) received RLR. After excluding cystic lesions, 113 cases were used for the analysis of perioperative parameters. Resected specimens were significantly bigger in the RLR vs. the LLR group (405 g vs. 169 g, p = 0.002); in addition, the tumor diameter was significantly larger in the RLR vs. the LLR group (5.6 cm vs. 3.7 cm, p = 0.001). Hence, the amount of major liver resections (three or more segments) was significantly higher in the RLR vs. the LLR group (39.0% vs. 16.7%, p = 0.005). The mean operative time was significantly longer in the RLR vs. the LLR group (331 min vs. 181 min, p = 0.0001). The postoperative hospital stay was significantly longer in the RLR vs. the LLR group (13.4 vs. LLR 8.7 days, p = 0.03). The R0 resection rate for solid tumors was higher in the RLR vs. the LLR group but without statistical significance (93.8% vs. 87.9%, p = 0.48). The postoperative morbidity ≥ Clavien-Dindo grade 3 was 5.6% in the LLR vs. 17.1% in the RLR group (p = 0.1). No patient died in the RLR but two patients (2.8%) died in the LLR group, 30 and 90 days after surgery (p = 0.53). Conclusion Minimally invasive liver surgery is safe and feasible. Robotic and laparoscopic liver surgery shows similar and adequate perioperative oncological results for selected patients. RLR might be advantageous for more advanced and technically challenging procedures.

Robotic Liver Surgery – Current Standards and Future Perspectives

2021 ◽  
Vol 59 (01) ◽  
pp. 56-62
Author(s):  
Felix Becker ◽  
Haluk Morgül ◽  
Shadi Katou ◽  
Mazen Juratli ◽  
Jens Peter Hölzen ◽  
...  
Keyword(s):  
Liver Surgery ◽  
German Literature ◽  
Minimal Invasive ◽  
Parenchymal Transection ◽  
Future Directions ◽  
Intracorporeal Suturing ◽  
Physiologic Tremor ◽  
Major Hepatectomies ◽  
Robotic Liver Surgery ◽  
Current Standards

Abstract Background Robotic liver surgery is emerging as the future of minimal invasive surgery. The robotic surgical system offers a stable camera platform, elimination of physiologic tremor, augmented surgical dexterity as well as improved ergonomics because of a seated operating position. Due to the theoretical advantages of the robotic assisted system, complex liver surgery might be an especially interesting indication for a robotic approach since it demands delicate tissue dissection, precise intracorporeal suturing as well as difficult parenchymal transection with subsequent need for meticulous hemostasis and biliostasis. Material and methods An analysis of English and German literature on open, laparoscopic and robotic liver surgery was performed and this review provides a general overview of the existing literature along with current standards and aims to specifically point out future directions of robotic liver surgery. Results Robotic liver surgery is safe and feasible compared to open and laparoscopic surgery, with improved short-term postoperative outcomes and at least non-inferior oncological outcomes. Conclusion In complex cases including major hepatectomies, extended hepatectomies with biliary reconstruction and difficult segmentectomies of the posterior-superior segments, robotic surgery appears to emerge as a reasonable alternative to open surgery rather than being an alternative to laparoscopic procedures.

scholarly journals Robotic Liver Surgery

2021 ◽  
Author(s):  
Mushfique Alam ◽  
Robert Young ◽  
Rafael Diaz-Nieto
Keyword(s):  
Laparoscopic Surgery ◽  
Minimally Invasive ◽  
Liver Surgery ◽  
Specific Aspect ◽  
Early Years ◽  
Supporting Evidence ◽  
Future Perspectives ◽  
Hepatobiliary Surgery ◽  
Minimally Invasive Liver Surgery ◽  
Robotic Liver Surgery

Minimally invasive surgery has experienced a significant expansion in the last decades. Robotic surgery has evolved in parallel to traditional laparoscopic surgery offering additional technical advantages. Some specific aspect of Hepatobiliary Surgery led to a limited implementation of minimally invasive liver surgery in the early years of laparoscopic surgery whilst we are experiencing an exponential increase in the use of minimally invasive approaches to this type of intervention. In this chapter we describe the key aspect of robotic liver surgery with a meticulous description of the supporting evidence, its limitation and future perspectives.

scholarly journals Augmented Reality and Image-Guided Robotic Liver Surgery

Cancers ◽  
2021 ◽  
Vol 13 (24) ◽  
pp. 6268
Author(s):  
Fabio Giannone ◽  
Emanuele Felli ◽  
Zineb Cherkaoui ◽  
Pietro Mascagni ◽  
Patrick Pessaux
Keyword(s):  
Artificial Intelligence ◽  
Augmented Reality ◽  
Liver Surgery ◽  
Tactile Feedback ◽  
Parenchymal Transection ◽  
Practical Applications ◽  
Indocyanine Green Fluorescence ◽  
Oncological Results ◽  
Vascular Structures ◽  
Robotic Liver Surgery

Artificial intelligence makes surgical resection easier and safer, and, at the same time, can improve oncological results. The robotic system fits perfectly with these more or less diffused technologies, and it seems that this benefit is mutual. In liver surgery, robotic systems help surgeons to localize tumors and improve surgical results with well-defined preoperative planning or increased intraoperative detection. Furthermore, they can balance the absence of tactile feedback and help recognize intrahepatic biliary or vascular structures during parenchymal transection. Some of these systems are well known and are already widely diffused in open and laparoscopic hepatectomies, such as indocyanine green fluorescence or ultrasound-guided resections, whereas other tools, such as Augmented Reality, are far from being standardized because of the high complexity and elevated costs. In this paper, we review all the experiences in the literature on the use of artificial intelligence systems in robotic liver resections, describing all their practical applications and their weaknesses.

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.

scholarly journals Robotic and laparoscopic liver surgery for colorectal liver metastases: an experience from a German Academic Center

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Mirhasan Rahimli ◽  
Aristotelis Perrakis ◽  
Vera Schellerer ◽  
Andrew Gumbs ◽  
Eric Lorenz ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Minimally Invasive ◽  
Liver Surgery ◽  
Colorectal Liver Metastases ◽  
Survival Rates ◽  
Long Term Outcomes ◽  
Short Term ◽  
Minimally Invasive Liver Surgery ◽  
Previous Abdominal Surgery

Abstract Background Minimally invasive liver surgery (MILS) in the treatment of colorectal liver metastases (CRLM) is increasing in incidence. The aim of this work was to present our experience by reporting short-term and long-term outcomes after MILS for CRLM with comparative analysis of laparoscopic (LLS) and robotic liver surgery (RLS). Methods Twenty-five patients with CRLM, who underwent MILS between May 2012 and March 2020, were selected from our retrospective registry of minimally invasive liver surgery (MD-MILS). Thirteen of these patients underwent LLS and 12 RLS. Short-term and long-term outcomes of both groups were analyzed. Results Operating time was significantly longer in the RLS vs. the LLS group (342.0 vs. 200.0 min; p = 0.004). There was no significant difference between the laparoscopic vs. the robotic group regarding length of postoperative stay (8.8 days), measured blood loss (430.4 ml), intraoperative blood transfusion, overall morbidity (20.0%), and liver surgery related morbidity (4%). The mean BMI was 27.3 (range from 19.2 to 44.8) kg/m2. The 30-day mortality was 0%. R0 resection was achieved in all patients (100.0%) in RLS vs. 10 patients (76.9%) in LLS. Major resections were carried out in 32.0% of the cases, and 84.0% of the patients showed intra-abdominal adhesions due to previous abdominal surgery. In 24.0% of cases, the tumor was bilobar, the maximum number of tumors removed was 9, and the largest tumor was 8.5 cm in diameter. The 1-, 3- and 5-year overall survival rates were 84, 56.9, and 48.7%, respectively. The 1- and 3-year overall recurrence-free survival rates were 49.6 and 36.2%, respectively, without significant differences between RLS vs. LLS. Conclusion Minimally invasive liver surgery for CRLM is safe and feasible. Minimally invasive resection of multiple lesions and large tumors is also possible. RLS may help to achieve higher rates of R0 resections. High BMI, previous abdominal surgery, and bilobar tumors are not a barrier for MILS. Laparoscopic and robotic liver resections for CRLM provide similar long-term results which are comparable to open techniques.

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