A Single Institution’s Experience With Robotic Minor and Major Hepatectomy

Background Minimally invasive liver resection is gradually becoming the preferred technique to treat liver tumors due its salutary benefits when compared with traditional “open” method. While robotic technology improves surgeon dexterity to better perform complex operations, outcomes of robotic hepatectomy have not been adequately studied. We therefore describe our institutional experience with robotic minor and major hepatectomy. Materials and Methods We prospectively study all patients undergoing robotic hepatectomy from 2016 to 2020. Results A total of 220 patients underwent robotic hepatectomy. 138 (63%) were major hepatectomies while 82 (37%) were minor hepatectomies. Median age was 63 (62 ± 13) years, 118 (54%) were female. 168 patients had neoplastic disease and 52 patients had benign disease. Lesion size in patients who had undergone minor hepatectomy was 2 (3 ± 2.5) cm, compared to 5 (5 ± 3.0) cm in patients who undergone major hepatectomy ( P < .001). 97% of patients underwent R0 resections while none of the patients had R2 resection. Operative duration was 226 (260 ± 122.7) vs 282 (299 ± 118.7) minutes ( P ≤ .05); estimated blood loss was 100 (163 ± 259.2) vs 200 (251 ± 246.7) mL ( P ≤ .05) for minor and major hepatectomy, respectively. One patient had intraoperative bleeding requiring “open” conversion. Nine (4%) patients had experienced notable postoperative complications and 2 (1%) patients died postoperatively. Length of stay was 3 (5 ± 4.6) vs 4 (5 ± 2.8) days for minor vs major hepatectomy ( P = .84). Reoperation and readmission rate for minor vs major hepatectomy was 1% vs 3% ( P = .65) and 9% vs 10% ( P = .81), respectively. Discussion Robotic major hepatectomy is safe, feasible, and efficacious with excellent postoperative outcomes.

Safety of intermittent Pringle maneuver during minimally invasive liver resection in patients with hepatocellular carcinoma with and without cirrhosis

Purpose The aim of this study was to analyze the impact of minimally invasive intermittent Pringle maneuver (IPM) on postoperative outcomes in patients with hepatocellular carcinoma (HCC) and liver cirrhosis. Methods In this retrospective cohort study, we evaluated the safety of IPM in patients with HCC who underwent minimally invasive liver resection during five years at our center. Factors influencing the use of IPM were examined in univariate and multivariate regression analysis. Cases with use of IPM (IPM) and those without use of IPM (no IPM) were then compared regarding intraoperative and postoperative outcomes after propensity score matching (PSM) for surgical difficulty. Results One hundred fifty-one patients underwent liver resection for HCC at our center and met inclusion criteria. Of these, 73 patients (48%) received IPM with a median duration of 18 min (5–78). One hundred patients (66%) had confirmed liver cirrhosis. In multivariate analysis, patients with large tumors (≥ 3 cm) and difficult tumor locations (segments VII or VIII) were more likely to undergo IPM (OR 1.176, p = 0.043, and OR 3.243, p = 0.001, respectively). After PSM, there were no differences in intraoperative blood transfusion or postoperative complication rates between the IPM and no IPM groups. Neither did we observe any differences in the subgroup analysis for cirrhotic patients. Postoperative serum liver function tests were not affected by the use of IPM. Conclusions Based on our findings, we conclude that the use of IPM in minimally invasive liver resection is safe and feasible for patients with HCC, including those with compensated liver cirrhosis.

Technical Modifications in Parenchymal Transection During Laparoscopic Liver Resection Do Not Confer to an Increased Rate of Cut Surface Complications Compared to Open CUSA Based Liver Resections – A Single Center Comparative Analysis

Background/AimsBiliary leakage (BL) is a major cause of postoperative morbidity after liver resection. Aim of our study was to analyse surgical parameters and postoperative morbidity with special emphasis on BL, after launching a minimally invasive liver resection program.MethodsA prospectively maintained medical database of patients who required a liver resection was used for analysis.ResultsA total of n=156 patients were divided into a group of n=47 patients (30.1%) receiving laparoscopic (LLR) and n=109 patients (69.9%) undergoing open liver resections (OLR). Patient age (OLR: 59.4 ± 16.0 vs. LLR: 57.9 ± 14.2 years) and male to female ratio (OLR: 63/46 vs. LLR: 25/22) were comparable. We performed n=75 (68.8%) major OLR and n=31 (66.0%) major LLR. Operation time was OLR 342.8 ± 110.5 min vs. LLR 287.3 ± 132.6 min (p=0.014) and the average blood loss was OLR 523.5 ± 428.6 ml vs. LLR 355.5 ± 459.2 ml. Morbidity and mortality was observed in n= 29 (18.6 %) and n= 7 (4.5 %) patients, respectively. The overall biliary leakage (BL) rate was 5.1% (n= 8). Majority of BL were detected in OLR with biliodigestive anastomosis (BDA) (n=2 (11.0%)) followed by OLR without BDA (n=6 (6.5%)). No BL were detected in patients with LLR. Hospital stay was significantly prolonged after OLR in patients with BL (38.4 ± 20.1 vs. 17.4 ± 11.1 days, p< 0.001).ConclusionIn line with previous reports, the introduction of different transection techniques in laparoscopic liver resections did not increase morbidity and BL-rate.