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Sijberden JP, Hoogteijling TJ, Aghayan D, Ratti F, Tan EK, Morrison-Jones V, Lanari J, Haentjens L, Wei K, Tzedakis S, Martinie J, Osei Bordom D, Zimmitti G, Crespo K, Magistri P, Russolillo N, Conci S, Görgec B, Benedetti Cacciaguerra A, D'Souza D, Zozaya G, Caula C, Geller D, Robles Campos R, Croner R, Rehman S, Jovine E, Efanov M, Alseidi A, Memeo R, Dagher I, Giuliante F, Sparrelid E, Ahmad J, Gallagher T, Schmelzle M, Swijnenburg RJ, Fretland ÅA, Cipriani F, Koh YX, White S, Lopez Ben S, Rotellar F, Serrano PE, Vivarelli M, Ruzzenente A, Ferrero A, Di Benedetto F, Besselink MG, Sucandy I, Sutcliffe RP, Vrochides D, Fuks D, Liu R, D'Hondt M, Cillo U, Primrose JN, Goh BKP, Aldrighetti LA, Edwin B, Abu Hilal M. Robotic Versus Laparoscopic Liver Resection in Various Settings: An International Multicenter Propensity Score Matched Study of 10.075 Patients. Ann Surg 2024; 280:108-117. [PMID: 38482665 DOI: 10.1097/sla.0000000000006267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
OBJECTIVE To compare the perioperative outcomes of robotic liver surgery (RLS) and laparoscopic liver surgery (LLS) in various settings. BACKGROUND Clear advantages of RLS over LLS have rarely been demonstrated, and the associated costs of robotic surgery are generally higher than those of laparoscopic surgery. Therefore, the exact role of the robotic approach in minimally invasive liver surgery remains to be defined. METHODS In this international retrospective cohort study, the outcomes of patients who underwent RLS and LLS for all indications between 2009 and 2021 in 34 hepatobiliary referral centers were compared. Subgroup analyses were performed to compare both approaches across several types of procedures: (1) minor resections in the anterolateral (2, 3, 4b, 5, and 6) or (2) posterosuperior segments (1, 4a, 7, 8), and (3) major resections (≥3 contiguous segments). Propensity score matching was used to mitigate the influence of selection bias. The primary outcome was textbook outcome in liver surgery (TOLS), previously defined as the absence of intraoperative incidents ≥grade 2, postoperative bile leak ≥grade B, severe morbidity, readmission, and 90-day or in-hospital mortality with the presence of an R0 resection margin in case of malignancy. The absence of a prolonged length of stay was added to define TOLS+. RESULTS Among the 10.075 included patients, 1.507 underwent RLS and 8.568 LLS. After propensity score matching, both groups constituted 1.505 patients. RLS was associated with higher rates of TOLS (78.3% vs 71.8%, P < 0.001) and TOLS+ (55% vs 50.4%, P = 0.026), less Pringle usage (39.1% vs 47.1%, P < 0.001), blood loss (100 vs 200 milliliters, P < 0.001), transfusions (4.9% vs 7.9%, P = 0.003), conversions (2.7% vs 8.8%, P < 0.001), overall morbidity (19.3% vs 25.7%, P < 0.001), and microscopically irradical resection margins (10.1% vs. 13.8%, P = 0.015), and shorter operative times (190 vs 210 minutes, P = 0.015). In the subgroups, RLS tended to have higher TOLS rates, compared with LLS, for minor resections in the posterosuperior segments (n = 431 per group, 75.9% vs 71.2%, P = 0.184) and major resections (n = 321 per group, 72.9% vs 67.5%, P = 0.086), although these differences did not reach statistical significance. CONCLUSIONS While both produce excellent outcomes, RLS might facilitate slightly higher TOLS rates than LLS.
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Affiliation(s)
- Jasper P Sijberden
- Department of Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Tijs J Hoogteijling
- Department of Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Davit Aghayan
- The Intervention Centre and Department of HPB Surgery, Oslo University Hospital and Institute of Medicine, University of Oslo, Oslo, Norway
- Department of Surgery, Ringerike Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Ek-Khoon Tan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore
| | - Victoria Morrison-Jones
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jacopo Lanari
- Department of Surgical, Oncological and Gastroenterological Sciences, General Surgery 2, Hepatopancreatobiliary Surgery and Liver Transplantation, Padua University Hospital, Padua, Italy
| | - Louis Haentjens
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Kongyuan Wei
- Faculty of Hepatopancreatobiliary Surgery, the First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Stylianos Tzedakis
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - John Martinie
- Department of Surgery, Division of HPB Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC
| | | | - Giuseppe Zimmitti
- Department of Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Kaitlyn Crespo
- Digestive Health Institute, AdventHealth Tampa, Tampa, FL
| | - Paolo Magistri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Nadia Russolillo
- Department of General and Oncological Surgery, Umberto I Mauriziano Hospital, Largo Turati, Turin, Italy
| | - Simone Conci
- Department of Surgery, University of Verona, Verona, Italy
| | - Burak Görgec
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Andrea Benedetti Cacciaguerra
- Department of Experimental and Clinical Medicine, Hepatobiliary and Abdominal Transplantation Surgery, Riuniti Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Daniel D'Souza
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Gabriel Zozaya
- Department of Surgery, HPB and Liver Transplantation Unit, University Clinic, Universidad de Navarra, Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
| | - Cèlia Caula
- Servei de Cirurgia General i Digestiva, Hospital Doctor Josep Trueta de Girona, Girona, Catalonia, Spain
| | - David Geller
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Ricardo Robles Campos
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain
| | - Roland Croner
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Shafiq Rehman
- Department of Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Elio Jovine
- Department of Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Mikhail Efanov
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia
| | - Adnan Alseidi
- Department of Surgery, Virginia Mason Medical Center, Seattle, WA
- Department of Surgery, University of California San Francisco, CA
| | - Riccardo Memeo
- Hepato-Pancreato-Biliary Surgery Unit, Miulli Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Ibrahim Dagher
- Department of Digestive Minimally Invasive Surgery, Antoine Béclère Hospital, Paris, France
| | - Felice Giuliante
- Chirurgia Epatobiliare, Università Cattolica del Sacro Cuore-IRCCS, Rome, Italy
| | - Ernesto Sparrelid
- Department for Clinical Science, Division of Surgery, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Jawad Ahmad
- University Hospitals Coventry and Warwickshire, Clifford Bridges Road, Coventry, UK
| | - Tom Gallagher
- St. Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Moritz Schmelzle
- Department of General, Visceral and Transplant Surgery, Medizinische Hochschule Hannover, Hannover, Germany
| | - Rutger-Jan Swijnenburg
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Åsmund Avdem Fretland
- The Intervention Centre and Department of HPB Surgery, Oslo University Hospital and Institute of Medicine, University of Oslo, Oslo, Norway
| | - Federica Cipriani
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Ye-Xin Koh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore
| | - Steven White
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Santi Lopez Ben
- Servei de Cirurgia General i Digestiva, Hospital Doctor Josep Trueta de Girona, Girona, Catalonia, Spain
| | - Fernando Rotellar
- Department of Surgery, HPB and Liver Transplantation Unit, University Clinic, Universidad de Navarra, Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
| | - Pablo E Serrano
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Marco Vivarelli
- Department of Experimental and Clinical Medicine, Hepatobiliary and Abdominal Transplantation Surgery, Riuniti Hospital, Polytechnic University of Marche, Ancona, Italy
| | | | - Alessandro Ferrero
- Department of General and Oncological Surgery, Umberto I Mauriziano Hospital, Largo Turati, Turin, Italy
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
| | | | | | - Dionisios Vrochides
- Department of Surgery, Division of Abdominal Transplantation, Carolinas Medical Center, Atrium Health, Charlotte, NC
| | - David Fuks
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Rong Liu
- Faculty of Hepatopancreatobiliary Surgery, the First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Mathieu D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Umberto Cillo
- Department of Surgical, Oncological and Gastroenterological Sciences, General Surgery 2, Hepatopancreatobiliary Surgery and Liver Transplantation, Padua University Hospital, Padua, Italy
| | - John N Primrose
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore
- Surgery Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Luca A Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Bjørn Edwin
- The Intervention Centre and Department of HPB Surgery, Oslo University Hospital and Institute of Medicine, University of Oslo, Oslo, Norway
| | - Mohammad Abu Hilal
- Department of Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Imai D, Yokoyama M, Sambommatsu Y, Khan AA, Kumaran V, Saeed MI, Lee H, Matherly S, Cotterell AH, Levy MF, Bruno DA, Lee SD, Sharma A. Initial Experience With Robotic Liver Resection in the United States. Am Surg 2024:31348241259043. [PMID: 38840297 DOI: 10.1177/00031348241259043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
BACKGROUND This study's aim was to show the feasibility and safety of robotic liver resection (RLR) even without extensive experience in major laparoscopic liver resection (LLR). METHODS A single center, retrospective analysis was performed for consecutive liver resections for solid liver tumors from 2014 to 2022. RESULTS The analysis included 226 liver resections, comprising 127 (56.2%) open surgeries, 28 (12.4%) LLR, and 71 (31.4%) RLR. The rate of RLR increased and that of LLR decreased over time. In a comparison between propensity score matching-selected open liver resection and RLR (41:41), RLR had significantly less blood loss (384 ± 413 vs 649 ± 646 mL, P = .030) and shorter hospital stay (4.4 ± 3.0 vs 6.4 ± 3.7 days, P = .010), as well as comparable operative time (289 ± 123 vs 290 ± 132 mins, P = .954). A comparison between LLR and RLR showed comparable perioperative outcomes, even with more surgeries with higher difficulty score included in RLR (5.2 ± 2.7 vs 4.3 ± 2.5, P = .147). The analysis of the learning curve in RLR demonstrated that blood loss, conversion rate, and complication rate consistently improved over time, with the case number required to achieve the learning curve appearing to be 60 cases. CONCLUSIONS The findings suggest that RLR is a feasible, safe, and acceptable platform for liver resection, and that the safe implementation and dissemination of RLR can be achieved without solid experience of LLR.
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Affiliation(s)
- Daisuke Imai
- Department of Surgery, Division of Transplant Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Masaya Yokoyama
- Department of Surgery, Division of Transplant Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Aamir A Khan
- Department of Surgery, Division of Transplant Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Vinay Kumaran
- Department of Surgery, Division of Transplant Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Muhammad I Saeed
- Department of Surgery, Division of Transplant Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Hannah Lee
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA, USA
| | - Scott Matherly
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA, USA
| | - Adrian H Cotterell
- Department of Surgery, Division of Transplant Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Marlon F Levy
- Department of Surgery, Division of Transplant Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - David A Bruno
- Department of Surgery, Division of Transplant Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Seung D Lee
- Department of Surgery, Division of Transplant Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Amit Sharma
- Department of Surgery, Division of Transplant Surgery, Virginia Commonwealth University, Richmond, VA, USA
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3
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Sucandy I, Vasanthakumar P, Ross SB, Pattilachan TM, Christodoulou M, App S, Rosemurgy A. Effect of IWATE laparoscopic difficulty score on postoperative outcomes and costs for robotic hepatectomy: Are complex resections more expensive? JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2024. [PMID: 38800881 DOI: 10.1002/jhbp.12003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
BACKGROUND The IWATE criteria, a four-level classification system for laparoscopic hepatectomy, measures technical complexity but lacks studies on its impact on outcomes and costs, especially in robotic surgeries. This study evaluated the effects of technical complexity on perioperative outcomes and costs in robotic hepatectomy. METHODS Since 2013, we prospectively followed 500 patients who underwent robotic hepatectomy. Patients were classified into four levels of IWATE scores; (low [0-3], intermediate [4-6], advanced [7-9], and expert [10-12]) determined by tumor characteristics, liver function and resection extent. Perioperative variables were analyzed with significance accepted at a p-value ≤.05. RESULTS Among 500 patients, 337 (67%) underwent advanced to expert-level operations. Median operative duration was 213 min (range: 16-817 min; mean ± SD: 240 ± 116.1 min; p < .001) and estimated blood loss (EBL) was 95 mL (range: 0-3500 mL; mean ± SD:142 ± 171.1 mL; p < .001). Both operative duration and EBL showed positive correlations with increasing IWATE scores. Median length of stay (LOS) of 3 days (range: 0-34; mean ± SD:4 ± 3.0 days; p < .001) significantly correlated with IWATE score. Total cost of $25 388 (range: $84-354 407; mean ± SD: 29752 ± 20106.8; p < .001) also significantly correlated with operative complexity, however hospital reimbursement did not. No correlation was found between IWATE score and postoperative complications or mortality. CONCLUSIONS Clinical variables such as operative duration, EBL, and LOS correlate with IWATE difficulty scores in robotic hepatectomy. Financial metrics such as costs but not reimbursement received by the hospital correlate with IWATE scores.
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Affiliation(s)
- Iswanto Sucandy
- Digestive Health Institute, AdventHealth Tampa, Tampa, Florida, USA
| | - Prakash Vasanthakumar
- Digestive Health Institute, AdventHealth Tampa, Tampa, Florida, USA
- University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Sharona B Ross
- Digestive Health Institute, AdventHealth Tampa, Tampa, Florida, USA
| | | | | | - Samantha App
- Digestive Health Institute, AdventHealth Tampa, Tampa, Florida, USA
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4
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Soyama A, Hamada T, Adachi T, Eguchi S. Current status and future perspectives of robotic liver surgery. Hepatol Res 2024. [PMID: 38801309 DOI: 10.1111/hepr.14058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/17/2024] [Accepted: 05/07/2024] [Indexed: 05/29/2024]
Abstract
Robotic liver resection has been reported in case series since the early 2000s. The surgical robot is capable of precise operation using articulated forceps with seven degrees of freedom. The robot also eliminates tremors and provides a good surgical field with highly detailed 3D high-definition images. The clinical results demonstrating their usefulness have been increasing year by year. Initially, a shorter hospital stay was observed in comparison with open hepatectomy. Recent reports have also shown lower conversion and complication rates in comparison with laparoscopic hepatectomy. The clamp and crush method with bipolar forceps, sealing devices, ultrasonic shears, and the combined procedure of Cavitron ultrasonic surgical aspirator and robotic forceps as hybrid procedures have been reported as effective methods of parenchymal transection in robotic surgery. Theoretically, the advantages of the robotic platform allow for more complex liver resection around hilar structures and major blood vessels, as well as for vascular reconstruction or biliary reconstruction. The application of robotic liver surgery for hilar cholangiocarcinoma, living donor hepatectomy, and living donor liver transplantation has been reported. Robotic liver surgery is becoming more popular for certain indications; however, it is important to further evaluate its long-term surgical and oncological outcomes and costs in comparison with conventional laparoscopic and open liver surgery, based on accumulated experience.
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Affiliation(s)
- Akihiko Soyama
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takashi Hamada
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomohiko Adachi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Koh YX, Zhao Y, Tan IEH, Tan HL, Chua DW, Loh WL, Tan EK, Teo JY, Au MKH, Goh BKP. Comparative cost-effectiveness of open, laparoscopic, and robotic liver resection: A systematic review and network meta-analysis. Surgery 2024:S0039-6060(24)00239-3. [PMID: 38782702 DOI: 10.1016/j.surg.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/25/2024] [Accepted: 04/11/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND This study evaluated the cost-effectiveness of open, laparoscopic, and robotic liver resection. METHODS A comprehensive literature review and Bayesian network meta-analysis were conducted. Surface under cumulative ranking area values, mean difference, odds ratio, and 95% credible intervals were calculated for all outcomes. Cluster analysis was performed to determine the most cost-effective clustering approach. Costs-morbidity, costs-mortality, and costs-efficacy were the primary outcomes assessed, with postoperative overall morbidity, mortality, and length of stay associated with total costs for open, laparoscopic, and robotic liver resection. RESULTS Laparoscopic liver resection incurred the lowest total costs (laparoscopic liver resection versus open liver resection: mean difference -2,529.84, 95% credible intervals -4,192.69 to -884.83; laparoscopic liver resection versus robotic liver resection: mean difference -3,363.37, 95% credible intervals -5,629.24 to -1,119.38). Open liver resection had the lowest procedural costs but incurred the highest hospitalization costs compared to laparoscopic liver resection and robotic liver resection. Conversely, robotic liver resection had the highest total and procedural costs but the lowest hospitalization costs. Robotic liver resection and laparoscopic liver resection had a significantly reduced length of stay than open liver resection and showed less postoperative morbidity. Laparoscopic liver resection resulted in the lowest readmission and liver-specific complication rates. Laparoscopic liver resection and robotic liver resection demonstrated advantages in costs-morbidity efficiency. While robotic liver resection offered notable benefits in mortality and length of stay, these were balanced against its highest total costs, presenting a nuanced trade-off in the costs-mortality and costs-efficacy analyses. CONCLUSION Laparoscopic liver resection represents a more cost-effective option for hepatectomy with superior postoperative outcomes and shorter length of stay than open liver resection. Robotic liver resection, though costlier than laparoscopic liver resection, along with laparoscopic liver resection, consistently exceeds open liver resection in surgical performance.
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Affiliation(s)
- Ye Xin Koh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore; Duke-National University of Singapore Medical School, Singapore; Liver Transplant Service, SingHealth Duke-National University of Singapore Transplant Centre, Singapore.
| | - Yun Zhao
- Group Finance Analytics, Singapore Health Services, Singapore
| | | | - Hwee Leong Tan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore; Duke-National University of Singapore Medical School, Singapore
| | - Darren Weiquan Chua
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore; Duke-National University of Singapore Medical School, Singapore; Liver Transplant Service, SingHealth Duke-National University of Singapore Transplant Centre, Singapore
| | - Wei-Liang Loh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore; Duke-National University of Singapore Medical School, Singapore
| | - Ek Khoon Tan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore; Duke-National University of Singapore Medical School, Singapore; Liver Transplant Service, SingHealth Duke-National University of Singapore Transplant Centre, Singapore
| | - Jin Yao Teo
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore; Duke-National University of Singapore Medical School, Singapore
| | - Marianne Kit Har Au
- Group Finance Analytics, Singapore Health Services, Singapore; Finance, SingHealth Community Hospitals, Singapore; Finance, Regional Health System & Strategic Finance, Singapore Health Services, Singapore
| | - Brian Kim Poh Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore; Duke-National University of Singapore Medical School, Singapore; Liver Transplant Service, SingHealth Duke-National University of Singapore Transplant Centre, Singapore
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6
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Lamberty SA, Hoelzen JP, Katou S, Becker F, Juratli MA, Andreou A, Morgül MH, Pascher A, Strücker B. Validation of the IWATE Criteria in Robotic-Assisted Liver Resections. J Clin Med 2024; 13:2697. [PMID: 38731226 PMCID: PMC11084793 DOI: 10.3390/jcm13092697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/25/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
Background/Objectives: The IWATE criteria are well-established as a helpful tool to preoperatively estimate the difficulty and perioperative outcome of laparoscopic liver resections. We evaluated the relationship between the IWATE criteria and the perioperative outcomes in robotic-assisted liver resections (RARLs). Methods: We retrospectively analyzed the data of 58 patients who underwent robotic-assisted liver surgery at our center between July 2019 and April 2023. The operative difficulty of every patient was graded according to the IWATE criteria and compared to the perioperative outcome. Results: The median operation time was 236.5 min (range 37-671 min), and the median length of stay was 6 days (range 3-37 min). The majority had no complications (65.5%; n = 38), 18 (31.0%) patients suffered from mild complications (CD ≤ 3A) and 2 patients (3.4%) suffered from relevant complications (CD ≥ 3B). We observed no deaths within 30 postoperative days. The surgery time, postoperative ICU stay and perioperative blood transfusions increased significantly with a higher difficulty level (p = < 0.001; p < 0.001; p = 0.016). The length of stay, conversion to open surgery (n = 2) and complication rate were not significantly linked to the resulting IWATE group. Conclusions: The IWATE criteria can be implemented in robotic-assisted liver surgery and can be helpful in preoperatively estimating the difficulty of robotic liver resections. Whether there is a "robotic effect" in minimally invasive liver resections has to be further clarified. The IWATE criteria can help to develop curricula for robotic training.
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7
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Bernardi L, Balzano E, Roesel R, Ghinolfi D, Vagelli F, Menconi G, Petrusic A, Mongelli F, Majno-Hurst P, De Simone P, Cristaudi A. Concomitant training in robotic and laparoscopic liver resections of low-to-intermediate difficulty score: a retrospective analysis of the learning curve. Sci Rep 2024; 14:3595. [PMID: 38351030 PMCID: PMC10864263 DOI: 10.1038/s41598-024-54253-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/10/2024] [Indexed: 02/16/2024] Open
Abstract
In the setting of minimally invasive liver surgery (MILS), training in robotic liver resections (RLR) usually follows previous experience in laparoscopic liver resections (LLR). The aim of our study was to assess the learning curve of RLR in case of concomitant training with LLR. We analyzed consecutive RLRs and LLRs by a surgeon trained simultaneously in both techniques (Surg1); while a second surgeon trained only in LLRs was used as control (Surg2). A regression model was used to adjust for confounders and a Cumulative Sum (CUSUM) analysis was carried out to assess the learning phases according to operative time and difficulty of the procedures (IWATE score). Two-hundred-forty-five procedures were identified (RobSurg1, n = 75, LapSurg1, n = 102, LapSurg2, n = 68). Mean IWATE was 4.0, 4.3 and 5.8 (p < 0.001) in each group. The CUSUM analysis of the adjusted operative times estimated the learning phase in 40 cases (RobSurg1), 40 cases (LapSurg1), 48 cases (LapSurg2); for IWATE score it was 38 cases (RobSurg1), 33 cases (LapSurg1), 38 cases (LapSurg2) respectively. Our preliminary experience showed a similar learning curve of 40 cases for low and intermediate difficulty RLR and LLR. Concomitant training in both techniques was safe and may be a practical option for starting a MILS program.
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Affiliation(s)
- Lorenzo Bernardi
- Department of Surgery, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Emanuele Balzano
- Hepato-Biliary Surgery and Liver Transplant Division, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy.
| | - Raffaello Roesel
- Department of Surgery, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Davide Ghinolfi
- Hepato-Biliary Surgery and Liver Transplant Division, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Filippo Vagelli
- Hepato-Biliary Surgery and Liver Transplant Division, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Giacomo Menconi
- Hepato-Biliary Surgery and Liver Transplant Division, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Antonietta Petrusic
- Department of Surgery, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Francesco Mongelli
- Department of Surgery, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Faculty of Biomedical Sciences, University of Southern Switzerland (USI), Lugano, Switzerland
| | - Pietro Majno-Hurst
- Department of Surgery, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Faculty of Biomedical Sciences, University of Southern Switzerland (USI), Lugano, Switzerland
| | - Paolo De Simone
- Hepato-Biliary Surgery and Liver Transplant Division, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
- Department of Surgical, Medical, Biochemical Pathology and Intensive Care, University of Pisa, Pisa, Italy
| | - Alessandra Cristaudi
- Department of Surgery, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Faculty of Biomedical Sciences, University of Southern Switzerland (USI), Lugano, Switzerland
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8
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Sijberden JP, Zimmitti G, Cipriani F, Furumaya A, Lanari J, Suhool A, Osei-Bordom D, Aghayan D, Jovine E, Ruzzenente A, Ardito F, D'Hondt M, Ferrero A, Benedetti Cacciaguerra A, Lopez-Ben S, Dagher I, Fuks D, Alseidi A, Rotellar F, di Benedetto F, Ratti F, Swijnenburg RJ, Gringeri E, Vivarelli M, Giuliante F, Edwin B, Sutcliffe RP, Primrose JN, Cillo U, Besselink MG, Aldrighetti LA, Abu Hilal M. Trends in the characteristics and perioperative outcomes of patients undergoing laparoscopic and open resections for benign liver lesions: An international multicenter retrospective cohort study of 845 patients. HPB (Oxford) 2024; 26:188-202. [PMID: 37989610 DOI: 10.1016/j.hpb.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/21/2023] [Accepted: 10/20/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Solid benign liver lesions (BLL) are increasingly discovered, but clear indications for surgical treatment are often lacking. Concomitantly, laparoscopic liver surgery is increasingly performed. The aim of this study was to assess if the availability of laparoscopic surgery has had an impact on the characteristics and perioperative outcomes of patients with BLL. METHODS This is a retrospective international multicenter cohort study, including patients undergoing a laparoscopic or open liver resection for BLL from 19 centers in eight countries. Patients were divided according to the time period in which they underwent surgery (2008-2013, 2014-2016, and 2017-2019). Unadjusted and risk-adjusted (using logistic regression) time-trend analyses were performed. The primary outcome was textbook outcome (TOLS), defined as the absence of intraoperative incidents ≥ grade 2, bile leak ≥ grade B, severe complications, readmission and 90-day or in-hospital mortality, with the absence of a prolonged length of stay added to define TOLS+. RESULTS In the complete dataset comprised of patients that underwent liver surgery for all indications, the proportion of patients undergoing liver surgery for benign disease remained stable (12.6% in the first time period, 11.9% in the second time period and 12.1% in the last time period, p = 0.454). Overall, 845 patients undergoing a liver resection for BLL in the first (n = 374), second (n = 258) or third time period (n = 213) were included. The rates of ASA-scores≥3 (9.9%-16%,p < 0.001), laparoscopic surgery (57.8%-77%,p < 0.001), and Pringle maneuver use (33.2%-47.2%,p = 0.001) increased, whereas the length of stay decreased (5 to 4 days,p < 0.001). There were no significant changes in the TOLS rate (86.6%-81.3%,p = 0.151), while the TOLS + rate increased from 41.7% to 58.7% (p < 0.001). The latter result was confirmed in the risk-adjusted analyses (aOR 1.849,p = 0.004). CONCLUSION The surgical treatment of BLL has evolved with an increased implementation of the laparoscopic approach and a decreased length of stay. This evolution was paralleled by stable TOLS rates above 80% and an increase in the TOLS + rate.
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Affiliation(s)
- Jasper P Sijberden
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy; Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands.
| | - Giuseppe Zimmitti
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Federica Cipriani
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - Alicia Furumaya
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Jacopo Lanari
- Department of Surgical, Oncological and Gastroenterological Sciences, General Surgery 2, Hepatopancreatobiliary Surgery and Liver Transplantation, Padua University Hospital, Padua, Italy
| | - Amal Suhool
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | | | - Davit Aghayan
- The Intervention Centre and Department of HPB Surgery, Oslo University Hospital and Institute of Medicine, University of Oslo, Oslo, Norway
| | - Elio Jovine
- Department of Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Francesco Ardito
- Chirurgia Epatobiliare, Università Cattolica Del Sacro Cuore-IRCCS, Rome, Italy
| | - Mathieu D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, Umberto I Mauriziano Hospital, Largo Turati 62, 10128, Turin, Italy
| | - Andrea Benedetti Cacciaguerra
- Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Riuniti Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Santi Lopez-Ben
- Servei de Cirurgia General i Digestiva, Hospital Doctor Josep Trueta de Girona, Girona, Catalonia, Spain
| | - Ibrahim Dagher
- Department of Digestive Minimally Invasive Surgery, Antoine Béclère Hospital, Paris, France
| | - David Fuks
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université Paris Descartes, Paris 75014, France
| | - Adnan Alseidi
- Department of Surgery, Virginia Mason Medical Center, Seattle, USA; Department of Surgery, University of California San Francisco, California, USA
| | - Fernando Rotellar
- HPB and Liver Transplantation Unit, Department of Surgery, University Clinic, Universidad de Navarra, Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
| | - Fabrizio di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - Rutger-Jan Swijnenburg
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Enrico Gringeri
- Department of Surgical, Oncological and Gastroenterological Sciences, General Surgery 2, Hepatopancreatobiliary Surgery and Liver Transplantation, Padua University Hospital, Padua, Italy
| | - Marco Vivarelli
- Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Riuniti Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Felice Giuliante
- Chirurgia Epatobiliare, Università Cattolica Del Sacro Cuore-IRCCS, Rome, Italy
| | - Bjørn Edwin
- The Intervention Centre and Department of HPB Surgery, Oslo University Hospital and Institute of Medicine, University of Oslo, Oslo, Norway
| | | | - John N Primrose
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Umberto Cillo
- Department of Surgical, Oncological and Gastroenterological Sciences, General Surgery 2, Hepatopancreatobiliary Surgery and Liver Transplantation, Padua University Hospital, Padua, Italy
| | - Marc G Besselink
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Luca A Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - Mohammad Abu Hilal
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy; Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
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9
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Na YH, Kim WB, Kang JS, Choi SB, Kim WJ. Early outcomes of single-port robotic left lateral sectionectomy in patients with hepatic tumor. Ann Surg Treat Res 2024; 106:78-84. [PMID: 38318091 PMCID: PMC10838653 DOI: 10.4174/astr.2024.106.2.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/08/2023] [Accepted: 12/22/2023] [Indexed: 02/07/2024] Open
Abstract
Purpose Laparoscopic left lateral sectionectomy (L-LLS) stands as a cornerstone procedure in hepatobiliary minimal surgery, frequently employed for various benign and malignant liver lesions. This study aimed to analyze the peri- and postoperative surgical outcomes of single-port robotic left lateral sectionectomy (SPR-LLS) vs. those of L-LLS in patients with hepatic tumors. Methods From January 2020 through June 2023, 12 patients underwent SPR-LLS. During the same period, 30 L-LLS procedures were performed. In total, 12 patients in the robotic group and 24 patients in the laparoscopic group were matched. Results When the SPR-LLS and L-LLS groups were compared, the operation time was longer in the SPR-LLS group with less blood loss and shorter hospital stay. Postoperative complications were observed in 3 patients in the L-LLS group (12.5%) and 1 patient in the SPR-LLS group (8.3%). Conclusion SPR-LLS using the da Vinci SP system was comparable to laparoscopic LLS in terms of surgical outcomes. SPR-LLS was associated with lower blood loss and less postoperative length of stay compared to L-LLS. These findings suggest that left lateral sectionectomy is technically feasible and safe with the da Vinci SP system in select patients.
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Affiliation(s)
- Young-Hyun Na
- Division of Pediatric Surgery, Department of Surgery, Korea University Guro Hospital, Korea University Medical College, Seoul, Korea
| | - Wan-Bae Kim
- Division of Hepatobiliary Pancreas Surgery, Department of Surgery, Korea University Guro Hospital, Korea University Medical College, Seoul, Korea
| | - Jae-Seung Kang
- Division of Hepatobiliary Pancreas Surgery, Department of Surgery, Korea University Guro Hospital, Korea University Medical College, Seoul, Korea
| | - Sae Byeol Choi
- Division of Hepatobiliary Pancreas Surgery, Department of Surgery, Korea University Guro Hospital, Korea University Medical College, Seoul, Korea
| | - Wan-Joon Kim
- Division of Hepatobiliary Pancreas Surgery, Department of Surgery, Korea University Guro Hospital, Korea University Medical College, Seoul, Korea
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10
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Knitter S, Maurer MM, Winter A, Dobrindt EM, Seika P, Ritschl PV, Raakow J, Pratschke J, Denecke C. Robotic-Assisted Ivor Lewis Esophagectomy Is Safe and Cost Equivalent Compared to Minimally Invasive Esophagectomy in a Tertiary Referral Center. Cancers (Basel) 2023; 16:112. [PMID: 38201540 PMCID: PMC10778089 DOI: 10.3390/cancers16010112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
In recent decades, robotic-assisted minimally invasive esophagectomy (RAMIE) has been increasingly adopted for patients with esophageal cancer (EC) or cancer of the gastroesophageal junction (GEJ). However, concerns regarding its costs compared to conventional minimally invasive esophagectomy (MIE) have emerged. This study examined outcomes and costs of RAMIE versus total MIE in 128 patients who underwent Ivor Lewis esophagectomy for EC/GEJ at our department between 2017 and 2021. Surgical costs were higher for RAMIE (EUR 12,370 vs. EUR 10,059, p < 0.001). Yet, median daily (EUR 2023 vs. EUR 1818, p = 0.246) and total costs (EUR 30,510 vs. EUR 29,180, p = 0.460) were comparable. RAMIE showed a lower incidence of postoperative pneumonia (8% vs. 25%, p = 0.029) and a trend towards shorter hospital stays (15 vs. 17 days, p = 0.205), which may have equalized total costs. Factors independently associated with higher costs included readmission to the intensive care unit (hazard ratio [HR] = 7.0), length of stay (HR = 13.5), anastomotic leak (HR = 17.0), and postoperative pneumonia (HR = 5.4). In conclusion, RAMIE does not impose an additional financial burden. This suggests that RAMIE may be considered as a valid alternative approach for esophagectomy. Attention to typical cost factors can enhance postoperative care across surgical methods.
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Affiliation(s)
- Sebastian Knitter
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Max M. Maurer
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Axel Winter
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Eva M. Dobrindt
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Philippa Seika
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Paul V. Ritschl
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Jonas Raakow
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Christian Denecke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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11
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Singh K, Kaistha S, Jain R, Khurana S. The yesterday, today and tomorrow of liver transplant. Med J Armed Forces India 2023; 79:638-644. [PMID: 37981927 PMCID: PMC10654371 DOI: 10.1016/j.mjafi.2023.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/20/2023] [Indexed: 11/21/2023] Open
Abstract
With a very long history of setbacks and successes, organ transplantation is one of the greatest medical achievements of the twentieth century. Liver transplantation is currently the most effective method for treating end-stage liver disease. From humble beginnings, improvements in surgical technique, perioperative management, and immunosuppressive therapy have yielded excellent graft and patient outcomes. Most established 'liver transplant' (LT) centres have a 1-year survival rate exceeding 90%, and a 3-year survival rate of over 80%. With immense success, the need for hepatic grafts substantially exceeds their availability. This problem has been partially addressed by using split grafts, living donor liver transplantation (LDLT), and extended criteria grafts (ECG). This article reviews the immense progress made in various aspects of LT including evaluation, increasing donor pool, surgical advances, immunosuppression and anaesthesia related aspects and the way forward. With ongoing cutting edge research in technologies like artificial liver devices, tissue bioengineering and hepatocyte 'farms', the future of LT is more exciting than ever before.
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Affiliation(s)
- K.J. Singh
- Dy Commandant, Army Hospital (R&R), Delhi Cantt, India
| | - Sumesh Kaistha
- Senior Advisor (Surgery) & GI Surgeon, Army Hospital (R&R), Delhi Cantt, India
| | - Rahul Jain
- Senior Advisor (Medicine) & Gastroenterologist, Army Hospital (R&R), Delhi Cantt, India
| | - Saurabh Khurana
- Classified Specialist (Anaesthesia), Army Hospital (R&R), Delhi Cantt, India
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12
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Berardi G, Ivanics T, Sapisochin G, Ratti F, Sposito C, Nebbia M, D'Souza DM, Pascual F, Tohme S, D'Amico FE, Alessandris R, Panetta V, Simonelli I, Del Basso C, Russolillo N, Fiorentini G, Serenari M, Rotellar F, Zimitti G, Famularo S, Hoffman D, Onkendi E, Lopez-Ben S, Caula C, Rompianesi G, Chopra A, Abu Hilal M, Torzilli G, Corvera C, Alseidi A, Helton S, Troisi RI, Simo K, Conrad C, Cescon M, Cleary S, Kwon CHD, Ferrero A, Ettorre GM, Cillo U, Geller D, Cherqui D, Serrano PE, Ferrone C, Mazzaferro V, Aldrighetti L, Kingham TP. Minimally Invasive Versus Open Liver Resections for Hepatocellular Carcinoma in Patients With Metabolic Syndrome. Ann Surg 2023; 278:e1041-e1047. [PMID: 36994755 DOI: 10.1097/sla.0000000000005861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
OBJECTIVE To compare minimally invasive (MILR) and open liver resections (OLRs) for hepatocellular carcinoma (HCC) in patients with metabolic syndrome (MS). BACKGROUND Liver resections for HCC on MS are associated with high perioperative morbidity and mortality. No data on the minimally invasive approach in this setting exist. MATERIAL AND METHODS A multicenter study involving 24 institutions was conducted. Propensity scores were calculated, and inverse probability weighting was used to weight comparisons. Short-term and long-term outcomes were investigated. RESULTS A total of 996 patients were included: 580 in OLR and 416 in MILR. After weighing, groups were well matched. Blood loss was similar between groups (OLR 275.9±3.1 vs MILR 226±4.0, P =0.146). There were no significant differences in 90-day morbidity (38.9% vs 31.9% OLRs and MILRs, P =0.08) and mortality (2.4% vs 2.2% OLRs and MILRs, P =0.84). MILRs were associated with lower rates of major complications (9.3% vs 15.3%, P =0.015), posthepatectomy liver failure (0.6% vs 4.3%, P =0.008), and bile leaks (2.2% vs 6.4%, P =0.003); ascites was significantly lower at postoperative day 1 (2.7% vs 8.1%, P =0.002) and day 3 (3.1% vs 11.4%, P <0.001); hospital stay was significantly shorter (5.8±1.9 vs 7.5±1.7, P <0.001). There was no significant difference in overall survival and disease-free survival. CONCLUSIONS MILR for HCC on MS is associated with equivalent perioperative and oncological outcomes to OLRs. Fewer major complications, posthepatectomy liver failures, ascites, and bile leaks can be obtained, with a shorter hospital stay. The combination of lower short-term severe morbidity and equivalent oncologic outcomes favor MILR for MS when feasible.
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Affiliation(s)
- Giammauro Berardi
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Surgery, San Camillo Forlanini Hospital, Rome, Italy
| | - Tommy Ivanics
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | | | - Francesca Ratti
- Division, San Raffaele Hospital, Hepatobiliary Surgery Milan, Italy
| | - Carlo Sposito
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Department of Surgery, HPB Surgery and Liver Transplantation, Istituto Nazionale Tumori IRCCS, Milan, Italy
| | - Martina Nebbia
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Daniel M D'Souza
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Franco Pascual
- Department of Surgery, Paul Brousse Hospital, Villejuif, Paris, France
| | - Samer Tohme
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | - Valentina Panetta
- L'altrastatistica Consultancy and Training, Biostatistics Department, Rome, Italy
| | - Ilaria Simonelli
- L'altrastatistica Consultancy and Training, Biostatistics Department, Rome, Italy
| | | | | | | | - Matteo Serenari
- Hepatobiliary surgery and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Fernando Rotellar
- Hepatobiliary and Liver Transplantation Unit, Department of Surgery, University Clinic, Universidad de Navarra, Pamplona, Spain; Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
| | - Giuseppe Zimitti
- Department of surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Simone Famularo
- Department of General Surgery, Humanitas University and Research Hospital, IRCCS, Milan, Italy
| | - Daniel Hoffman
- Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Edwin Onkendi
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Santiago Lopez-Ben
- Department of Surgery, Hospital Universitari Dr Josep Trueta de Girona, Girona, Spain
| | - Celia Caula
- Department of Surgery, Hospital Universitari Dr Josep Trueta de Girona, Girona, Spain
| | - Gianluca Rompianesi
- Division of HPB, Minimally Invasive and Robotic Surgery, Transplantation Service, Federico II University Naples
| | | | - Mohammed Abu Hilal
- Department of surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Guido Torzilli
- Department of General Surgery, Humanitas University and Research Hospital, IRCCS, Milan, Italy
| | - Carlos Corvera
- Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Scott Helton
- Department of Surgery, Virginia Mason Hospital and Seattle Medical Center, Seattle, WA
| | - Roberto I Troisi
- Division of HPB, Minimally Invasive and Robotic Surgery, Transplantation Service, Federico II University Naples
| | - Kerri Simo
- Department of Surgery, Promedica Toledo, Toledo, OH
| | - Claudius Conrad
- Department of Surgery, Saint Elizabeth Medical Center, Boston, MA
| | - Matteo Cescon
- Hepatobiliary surgery and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Sean Cleary
- Department of Surgery, Mayo Clinic, Rochester, NY
| | | | | | | | - Umberto Cillo
- Department of Surgery, University of Padua, Padua, Italy
| | - David Geller
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Daniel Cherqui
- Department of Surgery, Paul Brousse Hospital, Villejuif, Paris, France
| | - Pablo E Serrano
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Cristina Ferrone
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Vincenzo Mazzaferro
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Department of Surgery, HPB Surgery and Liver Transplantation, Istituto Nazionale Tumori IRCCS, Milan, Italy
| | - Luca Aldrighetti
- Division, San Raffaele Hospital, Hepatobiliary Surgery Milan, Italy
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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13
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Navinés-López J, Pardo Aranda F, Cremades Pérez M, Espin Álvarez F, Zárate Pinedo A, Sentí Farrarons S, Galofré Recasens M, Cugat Andorrà E. Robotic liver surgery: A new reality. Descriptive analysis of 220 cases of minimally invasive liver surgery in 182 patients. Cir Esp 2023; 101:746-754. [PMID: 37105365 DOI: 10.1016/j.cireng.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 02/12/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION The level of recommendation of the robotic approach in liver surgery is controversial. The objective of the study is to carry out a single-center retrospective descriptive analysis of the short-term results of the robotic and laparoscopic approach in liver surgery during the same period. METHODS Descriptive analysis of the short-term results of the robotic and laparoscopic approach on 220 resections in 182 patients undergoing minimally invasive liver surgery. RESULTS Between April 2018 and June 2022, a total of 92 robotic liver resections (RLR) were performed in 83 patients and 128 laparoscopic (LLR) in 99 patients. The LLR group showed a higher proportion of major surgery (P < .001) and multiple resections (P = .002). The two groups were similar in anatomical resections (RLR 64.1% vs. LLR 56.3%). In the LLS group, the average operating time was 212 min (SD 52.1). Blood loss was 276.5 mL (100-1000) and conversion 12.1%. Mean hospital stay was 5.7 (SD 4.9) days. Morbidity was 27.3% and 2% mortality. In the RLS group, the mean operative time was 217 min (SD 53.6), blood loss 169.5 mL (100.900), and conversion 2.5%. Mean hospital stay was 4.1 (SD 2.1) days. Morbidity was 15%, with no mortality. CONCLUSION Minimally invasive liver surgery is a safe technique, and in particular, RLS allows liver resections to be performed safely and reproducibly; it appears to be a non-inferior technique to LLS, but randomized studies are needed to determine the minimally invasive approach of choice in liver surgery.
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Affiliation(s)
- Jordi Navinés-López
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y Digestiva, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Fernando Pardo Aranda
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y Digestiva, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain.
| | - Manel Cremades Pérez
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y Digestiva, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Francisco Espin Álvarez
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y Digestiva, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Alba Zárate Pinedo
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y Digestiva, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Sara Sentí Farrarons
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y Digestiva, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Maria Galofré Recasens
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y Digestiva, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Esteban Cugat Andorrà
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y Digestiva, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
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14
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Balzano E, Bernardi L, Roesel R, Vagelli F, Ghinolfi D, Tincani G, Catalano G, Melandro F, Petrusic A, Popeskou SG, Christoforidis D, Majno-Hurst P, De Simone P, Cristaudi A. Robotic versus laparoscopic liver resections: propensity-matched comparison of two-center experience. Surg Endosc 2023; 37:8123-8132. [PMID: 37721588 DOI: 10.1007/s00464-023-10358-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/30/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND The advantages of the robotic approach in minimally invasive liver surgery (MILS) are still debated. This study compares the short-term outcomes between laparoscopic (LLR) and robotic (RLR) liver resections in propensity score matched cohorts. METHODS Data regarding minimally invasive liver resections in two liver surgery units were retrospectively reviewed. A propensity score matched analysis (1:1 ratio) identified two groups of patients with similar characteristics. Intra- and post-operative outcomes were then compared. The difficulty of MILS was based on the IWATE criteria. RESULTS Two hundred sixty-nine patients underwent MILS between January 2014 and December 2021 (LLR = 192; RLR = 77). Propensity score matching identified 148 cases (LLR = 74; RLR = 74) consisting of compensated cirrhotic patients (100%) underwent non-anatomic resection of IWATE 1-2 class (90.5%) for a solitary tumor < 5 cm in diameter (93.2%). In such patients, RLRs had shorter operative time (227 vs. 250 min, p = 0.002), shorter Pringle's cumulative time (12 vs. 28 min, p < 0.0001), and less blood loss (137 vs. 209 cc, p = 0.006) vs. LLRs. Conversion rate was nihil (both groups). In RLRs compared to LLRs, R0 rate (93 vs. 96%, p > 0.71) and major morbidity (4.1 vs. 5.4%, p > 0.999) were similar, without post-operative mortality. Hospital stay was shorter in the robotic group (6.2 vs. 6.6, p = 0.0001). CONCLUSION This study supports the non-inferiority of RLR over LLR. In compensated cirrhotic patients underwent resection of low-to-intermediate difficulty for a solitary nodule < 5 cm, RLR was faster, with less blood loss despite the shorter hilar clamping, and required shorter hospitalization compared to LLR.
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Affiliation(s)
- Emanuele Balzano
- Hepato-Biliary Surgery and Liver Transplant Unit, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - Lorenzo Bernardi
- Department of Surgery, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Raffaello Roesel
- Department of Surgery, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Filippo Vagelli
- Hepato-Biliary Surgery and Liver Transplant Unit, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Davide Ghinolfi
- Hepato-Biliary Surgery and Liver Transplant Unit, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Giovanni Tincani
- Hepato-Biliary Surgery and Liver Transplant Unit, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Gabriele Catalano
- Hepato-Biliary Surgery and Liver Transplant Unit, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Fabio Melandro
- Hepato-Biliary Surgery and Liver Transplant Unit, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Antonietta Petrusic
- Department of Surgery, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | | | - Dimitri Christoforidis
- Department of Surgery, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Department of Biomedical Sciences, University of Southern Switzerland (USI), Lugano, Switzerland
| | - Pietro Majno-Hurst
- Department of Surgery, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Department of Biomedical Sciences, University of Southern Switzerland (USI), Lugano, Switzerland
| | - Paolo De Simone
- Hepato-Biliary Surgery and Liver Transplant Unit, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
- Department of Surgical, Medical, Biochemical Pathology and Intensive Care, University of Pisa, Pisa, Italy
| | - Alessandra Cristaudi
- Department of Surgery, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Department of Biomedical Sciences, University of Southern Switzerland (USI), Lugano, Switzerland
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15
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Sucandy I, Kang RD, Adorno J, Crespo K, Syblis C, Ross S, Rosemurgy A. Validity of the Institut Mutualiste Montsouris classification system for robotic liver resection. HPB (Oxford) 2023; 25:1022-1029. [PMID: 37217370 DOI: 10.1016/j.hpb.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/29/2023] [Accepted: 05/07/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND The Institut Mutualiste Montsouris (IMM) classification system is one of several widely accepted difficulty scoring systems for laparoscopic liver resections. Nothing is yet known about the applicability of this system for robotic liver resections. METHODS We conducted a retrospective review of 359 patients undergoing robotic hepatectomies between 2016 and 2022. Resections were classified into low, intermediate, and high difficulty level. Data were analyzed utilizing ANOVA of repeated measures, 3 x 2 contingency tables, and area under the receiving operating characteristic (AUROC) curves. Data are presented as median (mean ± SD). RESULTS Of the 359 patients, 117 were classified as low-difficulty level, 92 as intermediate, and 150 as high. The IMM system correlates well with tumor size (p = 0.002). The IMM system was a strong predictor of intraoperative outcomes including operative duration (p<0.001) and estimated blood loss (EBL) (p<0.001). The IMM system also showed a strong calibration for predicting an open conversion (AUC=0.705) and intraoperative complications (AUC=0.79). In contrast, the IMM system was a poor predictor of postoperative complications, mortality, and readmission. CONCLUSION The IMM system provides a strong correlation with intraoperative, but not postoperative outcomes. A dedicated difficulty scoring system should be developed for robotic hepatectomy.
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Affiliation(s)
- Iswanto Sucandy
- AdventHealth Tampa, Digestive Health Institute, Tampa, FL, USA.
| | - Richard D Kang
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | | | - Kaitlyn Crespo
- AdventHealth Tampa, Digestive Health Institute, Tampa, FL, USA
| | - Cameron Syblis
- AdventHealth Tampa, Digestive Health Institute, Tampa, FL, USA
| | - Sharona Ross
- AdventHealth Tampa, Digestive Health Institute, Tampa, FL, USA
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Winckelmans T, Wicherts DA, Parmentier I, De Meyere C, Verslype C, D'Hondt M. Robotic Versus Laparoscopic Hepatectomy: A Single Surgeon Experience of 629 Consecutive Minimally Invasive Liver Resections. World J Surg 2023; 47:2241-2249. [PMID: 37208537 DOI: 10.1007/s00268-023-07060-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Robotic surgery has the potential to broaden the indications for minimally invasive liver surgery owing to its technical advantages. This paper compares our experience with robotic liver surgery (RLS) with conventional laparoscopic liver surgery (LLS). METHODS All consecutive liver resections between October 2011 and October 2022 were selected from our prospective database to be included in this cohort study. Patients who underwent RLS were compared with a LLS group for operative and postoperative outcomes. RESULTS In total, 629 patients were selected from our database, including 177 patients who underwent a RLS and 452 patients who had LLS. Colorectal liver metastasis was the main indication for surgery in both groups. With the introduction of RLS, the percentage of open resections decreased significantly (32.6% from 2011 to 2020 vs. 11.5% from 2020 onward, P < 0.001). In the robotic group, redo liver surgery was more frequent (24.3% vs. 16.8%, P = 0.031) and the Southampton difficulty score was higher (4 [IQR 4 to 7] vs. 4 [IQR 3 to 6], P = 0.02). Median blood loss was lower (30 vs. 100 ml, P < 0.001), and postoperative length of stay (LOS) was shorter in the robotic group (median 3 vs. 4 days, P < 0.001). There was no significant difference in postoperative complications. Cost related to the used instruments and LOS was significantly lower in the RLS group (median €1483 vs. €1796, P < 0.001 and €1218 vs. €1624, P < 0.001, respectively), while cost related to operative time was higher (median €2755 vs. €2470, P < 0.001). CONCLUSIONS RLS may allow for a higher percentage of liver resections to be completed in a minimally invasive way with lower blood loss and a shorter LOS.
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Affiliation(s)
- Thomas Winckelmans
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium
| | - Dennis A Wicherts
- Department of Abdominal and Hepatobiliary/Pancreatic Surgery, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Isabelle Parmentier
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium
- Department of Oncology and Statistics, Groeninge Hospital, President Kennedylaan 4, Kortrijk, België
| | - Celine De Meyere
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium
| | - Chris Verslype
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium
- Department of Abdominal and Hepatobiliary/Pancreatic Surgery, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
- Department of Gastroenterology and Hepatology, KU Leuven, Leuven, Belgium
| | - Mathieu D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium.
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17
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Kinoshita M, Kawaguchi T, Tanaka S, Kimura K, Shinkawa H, Ohira G, Nishio K, Tanaka R, Kurihara S, Kushiyama S, Ishizawa T. Application of Indocyanine Green Fluorescence Imaging for Tumor Localization during Robot-Assisted Hepatectomy. Cancers (Basel) 2023; 15:4205. [PMID: 37686481 PMCID: PMC10487047 DOI: 10.3390/cancers15174205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/19/2023] [Accepted: 08/20/2023] [Indexed: 09/10/2023] Open
Abstract
The efficacy of indocyanine green (ICG) fluorescence imaging for visualizing hepatic tumors in robot-assisted hepatectomy (RAH) should be validated. This study included 30 consecutive patients with 33 collective tumors who underwent RAH. ICG was administered at a dose of 0.5 mg/kg before surgery. ICG fluorescence imaging was performed intraoperatively. In total, 28 patients with a combined total of 31 tumors underwent ICG fluorescence imaging. Further, 26 (84%) tumors were identified on hepatic surfaces prior to hepatic transection. The fluorescence signals of eight tumors were detected on hepatic raw surfaces during parenchymal dissection, thereby enabling surgeons to adjust the transection planes to ensure appropriate surgical margins. One patient with intrahepatic cholangiocarcinoma tested positive for cancer cells at the dissected stump of the bile duct. However, in all patients in whom ICG fluorescence imaging was used, negative surgical margins were achieved at the site of the dissected hepatic parenchyma. On the other hand, one of two patients with ICG contraindications had a positive surgical margin surrounding the dissected hepatic parenchyma. The median operative time and volume of blood loss were 259 (range: 124-594) min and 150 (range: 1-1150) mL, respectively. ICG fluorescence imaging facilitates the easy identification of hepatic tumors, even in RAH. Hence, it can be useful for confirming appropriate surgical margins.
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Affiliation(s)
- Masahiko Kinoshita
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan; (M.K.); (T.K.); (K.K.); (H.S.); (G.O.); (K.N.); (R.T.); (S.K.); (S.K.)
| | - Takahito Kawaguchi
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan; (M.K.); (T.K.); (K.K.); (H.S.); (G.O.); (K.N.); (R.T.); (S.K.); (S.K.)
| | - Shogo Tanaka
- Department of Hepato-Biliary-Pancreatic Surgery, Izumi City General Hospital, Izumi City 594-0073, Japan;
| | - Kenjiro Kimura
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan; (M.K.); (T.K.); (K.K.); (H.S.); (G.O.); (K.N.); (R.T.); (S.K.); (S.K.)
| | - Hiroji Shinkawa
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan; (M.K.); (T.K.); (K.K.); (H.S.); (G.O.); (K.N.); (R.T.); (S.K.); (S.K.)
| | - Go Ohira
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan; (M.K.); (T.K.); (K.K.); (H.S.); (G.O.); (K.N.); (R.T.); (S.K.); (S.K.)
| | - Kohei Nishio
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan; (M.K.); (T.K.); (K.K.); (H.S.); (G.O.); (K.N.); (R.T.); (S.K.); (S.K.)
| | - Ryota Tanaka
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan; (M.K.); (T.K.); (K.K.); (H.S.); (G.O.); (K.N.); (R.T.); (S.K.); (S.K.)
| | - Shigeaki Kurihara
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan; (M.K.); (T.K.); (K.K.); (H.S.); (G.O.); (K.N.); (R.T.); (S.K.); (S.K.)
| | - Shuhei Kushiyama
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan; (M.K.); (T.K.); (K.K.); (H.S.); (G.O.); (K.N.); (R.T.); (S.K.); (S.K.)
| | - Takeaki Ishizawa
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan; (M.K.); (T.K.); (K.K.); (H.S.); (G.O.); (K.N.); (R.T.); (S.K.); (S.K.)
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18
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Montalti R, Giglio MC, Wu AGR, Cipriani F, D'Silva M, Suhool A, Nghia PP, Kato Y, Lim C, Herman P, Coelho FF, Schmelzle M, Pratschke J, Aghayan DL, Liu Q, Marino MV, Belli A, Chiow AKH, Sucandy I, Ivanecz A, Di Benedetto F, Choi SH, Lee JH, Park JO, Prieto M, Guzman Y, Fondevila C, Efanov M, Rotellar F, Choi GH, Robles-Campos R, Wang X, Sutcliffe RP, Tang CN, Chong CC, D'Hondt M, Dalla Valle B, Ruzzenente A, Kingham TP, Scatton O, Liu R, Mejia A, Mishima K, Wakabayashi G, Lopez-Ben S, Pascual F, Cherqui D, Forchino F, Ferrero A, Ettorre GM, Levi Sandri GB, Sugioka A, Edwin B, Cheung TT, Long TCD, Abu Hilal M, Aldrighetti L, Fuks D, Han HS, Troisi RI, Goh BKP. Risk Factors and Outcomes of Open Conversion During Minimally Invasive Major Hepatectomies: An International Multicenter Study on 3880 Procedures Comparing the Laparoscopic and Robotic Approaches. Ann Surg Oncol 2023; 30:4783-4796. [PMID: 37202573 DOI: 10.1245/s10434-023-13525-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/27/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Despite the advances in minimally invasive (MI) liver surgery, most major hepatectomies (MHs) continue to be performed by open surgery. This study aimed to evaluate the risk factors and outcomes of open conversion during MI MH, including the impact of the type of approach (laparoscopic vs. robotic) on the occurrence and outcomes of conversions. METHODS Data on 3880 MI conventional and technical (right anterior and posterior sectionectomies) MHs were retrospectively collected. Risk factors and perioperative outcomes of open conversion were analyzed. Multivariate analysis, propensity score matching, and inverse probability treatment weighting analysis were performed to control for confounding factors. RESULTS Overall, 3211 laparoscopic MHs (LMHs) and 669 robotic MHs (RMHs) were included, of which 399 (10.28%) had an open conversion. Multivariate analyses demonstrated that male sex, laparoscopic approach, cirrhosis, previous abdominal surgery, concomitant other surgery, American Society of Anesthesiologists (ASA) score 3/4, larger tumor size, conventional MH, and Institut Mutualiste Montsouris classification III procedures were associated with an increased risk of conversion. After matching, patients requiring open conversion had poorer outcomes compared with non-converted cases, as evidenced by the increased operation time, blood transfusion rate, blood loss, hospital stay, postoperative morbidity/major morbidity and 30/90-day mortality. Although RMH showed a decreased risk of conversion compared with LMH, converted RMH showed increased blood loss, blood transfusion rate, postoperative major morbidity and 30/90-day mortality compared with converted LMH. CONCLUSIONS Multiple risk factors are associated with conversion. Converted cases, especially those due to intraoperative bleeding, have unfavorable outcomes. Robotic assistance seemed to increase the feasibility of the MI approach, but converted robotic procedures showed inferior outcomes compared with converted laparoscopic procedures.
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Affiliation(s)
- Roberto Montalti
- Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, Federico II University Hospital Naples, Naples, Italy
| | - Mariano Cesare Giglio
- Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, Federico II University Hospital Naples, Naples, Italy
| | - Andrew G R Wu
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital/National Cancer Centre Singapore and Ministry of Health Holdings, Singapore, Singapore
| | - Federica Cipriani
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - Mizelle D'Silva
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Amal Suhool
- Department of Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - Phan Phuoc Nghia
- Department of Hepatopancreatobiliary Surgery, University Medical Center, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Yutaro Kato
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Chetana Lim
- Department of Digestive, HBP and Liver Transplantation, Hopital Pitie-Salpetriere, Sorbonne Universite, Paris, France
| | - Paulo Herman
- Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Fabricio Ferreira Coelho
- Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Moritz Schmelzle
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Davit L Aghayan
- The Intervention Centre and Department of HPB Surgery, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Qiu Liu
- Faculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Marco V Marino
- General Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, and Oncologic Surgery Department, P. Giaccone University Hospital, Palermo, Italy
| | - Andrea Belli
- Division of Hepatopancreatobiliary Surgical Oncology, Department of Abdominal Oncology, National Cancer Center - IRCCS-G, Pascale, Naples, Italy
| | - Adrian K H Chiow
- Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital, Singapore, Singapore
| | - Iswanto Sucandy
- AdventHealth Tampa, Digestive Health Institute, Tampa, FL, USA
| | - Arpad Ivanecz
- Department of Abdominal and General Surgery, University Medical Center Maribor, Maribor, Slovenia
| | - Fabrizio Di Benedetto
- HPB Surgery and Liver Transplant Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Sung Hoon Choi
- Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jae Hoon Lee
- Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - James O Park
- Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - Mikel Prieto
- Hepatobiliary Surgery and Liver Transplantation Unit, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
| | - Yoelimar Guzman
- General and Digestive Surgery, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Constantino Fondevila
- General and Digestive Surgery, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
- General and Digestive Surgery, Hospital Universitario La Paz, IdiPAZ, CIBERehd, Madrid, Spain
| | - Mikhail Efanov
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia
| | - Fernando Rotellar
- HPB and Liver Transplant Unit, Department of General Surgery, Clinica Universidad de Navarra, Universidad de Navarra and Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
| | - Gi-Hong Choi
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ricardo Robles-Campos
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain
| | - Xiaoying Wang
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Robert P Sutcliffe
- Department of Hepatopancreatobiliary and Liver Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Chung Ngai Tang
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong, SAR, China
| | - Charing C Chong
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong, SAR, China
| | - Mathieu D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Bernardo Dalla Valle
- General and Hepatobiliary Surgery, Department of Surgery, Dentistry, Gynecology and Pediatrics University of Verona, GB Rossi Hospital, Verona, Italy
| | - Andrea Ruzzenente
- General and Hepatobiliary Surgery, Department of Surgery, Dentistry, Gynecology and Pediatrics University of Verona, GB Rossi Hospital, Verona, Italy
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Olivier Scatton
- Department of Digestive, HBP and Liver Transplantation, Hopital Pitie-Salpetriere, Sorbonne Universite, Paris, France
| | - Rong Liu
- Faculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Alejandro Mejia
- The Liver Institute, Methodist Dallas Medical Center, Dallas, TX, USA
| | - Kohei Mishima
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan
| | - Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan
| | - Santiago Lopez-Ben
- Hepatobiliary and Pancreatic Surgery Unit, Department of Surgery, Dr. Josep Trueta Hospital, IdIBGi, Girona, Spain
| | - Franco Pascual
- Department of Hepatobiliary Surgery, Assistance Publique Hopitaux de Paris, Centre Hepato-Biliaire, Paul-Brousse Hospital, Villejuif, France
| | - Daniel Cherqui
- Department of Hepatobiliary Surgery, Assistance Publique Hopitaux de Paris, Centre Hepato-Biliaire, Paul-Brousse Hospital, Villejuif, France
| | - Fabio Forchino
- Department of General and Oncological Surgery, Mauriziano Hospital, Turin, Italy
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, Mauriziano Hospital, Turin, Italy
| | - Giuseppe Maria Ettorre
- Division of General Surgery and Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | | | - Atsushi Sugioka
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Bjørn Edwin
- The Intervention Centre and Department of HPB Surgery, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tan-To Cheung
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, SAR, China
| | - Tran Cong Duy Long
- Department of Hepatopancreatobiliary Surgery, University Medical Center, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Mohammad Abu Hilal
- Department of Surgery, University Hospital Southampton, Southampton, UK
- Department of Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - David Fuks
- Department of Digestive, Oncologic and Metabolic Surgery, Institute Mutualiste Montsouris, Universite Paris Descartes, Paris, France
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Roberto I Troisi
- Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, Federico II University Hospital Naples, Naples, Italy.
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore.
- Surgery Academic Clinical Programme, Duke National University Singapore Medical School, Singapore, Singapore.
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19
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Görgec B, Zwart M, Nota CL, Bijlstra OD, Bosscha K, de Boer MT, de Wilde RF, Draaisma WA, Gerhards MF, Liem MS, Lips DJ, Marsman HA, Mieog JSD, Molenaar QI, Nijkamp M, Te Riele WW, Terkivatan T, Vahrmeijer AL, Besselink MG, Swijnenburg RJ, Hagendoorn J. Implementation and Outcome of Robotic Liver Surgery in the Netherlands: A Nationwide Analysis. Ann Surg 2023; 277:e1269-e1277. [PMID: 35848742 PMCID: PMC10174096 DOI: 10.1097/sla.0000000000005600] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the nationwide implementation and surgical outcome of minor and major robotic liver surgery (RLS) and assess the first phase of implementation of RLS during the learning curve. BACKGROUND RLS may be a valuable alternative to laparoscopic liver surgery. Nationwide population-based studies with data on implementation and outcome of RLS are lacking. METHODS Multicenter retrospective cohort study including consecutive patients who underwent RLS for all indications in 9 Dutch centers (August 2014-March 2021). Data on all liver resections were obtained from the mandatory nationwide Dutch Hepato Biliary Audit (DHBA) including data from all 27 centers for liver surgery in the Netherlands. Outcomes were stratified for minor, technically major, and anatomically major RLS. Learning curve effect was assessed using cumulative sum analysis for blood loss. RESULTS Of 9437 liver resections, 400 were RLS (4.2%) procedures including 207 minor (52.2%), 141 technically major (35.3%), and 52 anatomically major (13%). The nationwide use of RLS increased from 0.2% in 2014 to 11.9% in 2020. The proportion of RLS among all minimally invasive liver resections increased from 2% to 28%. Median blood loss was 150 mL (interquartile range 50-350 mL] and the conversion rate 6.3% (n=25). The rate of Clavien-Dindo grade ≥III complications was 7.0% (n=27), median length of hospital stay 4 days (interquartile range 2-5) and 30-day/in-hospital mortality 0.8% (n=3). The R0 resection rate was 83.2% (n=263). Cumulative sum analysis for blood loss found a learning curve of at least 33 major RLS procedures. CONCLUSIONS The nationwide use of RLS in the Netherlands has increased rapidly with currently one-tenth of all liver resections and one-fourth of all minimally invasive liver resections being performed robotically. Although surgical outcomes of RLS in selected patient seem favorable, future prospective studies should determine its added value.
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Affiliation(s)
- Burak Görgec
- Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Maurice Zwart
- Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Carolijn L. Nota
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Okker D. Bijlstra
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Koop Bosscha
- Department of Surgery, Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands
| | - Marieke T. de Boer
- Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Roeland F. de Wilde
- Department of Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Werner A. Draaisma
- Department of Surgery, Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands
| | | | - Mike S. Liem
- Department of Surgery, Medical Spectrum Twente, Enschede, the Netherlands
| | - Daan J. Lips
- Department of Surgery, Medical Spectrum Twente, Enschede, the Netherlands
| | | | - J. Sven D. Mieog
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Quintus I. Molenaar
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Maarten Nijkamp
- Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Wouter W. Te Riele
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Türkan Terkivatan
- Department of Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Marc G. Besselink
- Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Rutger-Jan Swijnenburg
- Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands
| | - Jeroen Hagendoorn
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
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20
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Yoshino O, Wang Y, McCarron F, Motz B, Wang H, Baker E, Iannitti D, Martinie JB, Vrochides D. Major hepatectomy in elderly patients: possible benefit from robotic platform utilization. Surg Endosc 2023:10.1007/s00464-023-10062-5. [PMID: 37173594 DOI: 10.1007/s00464-023-10062-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 04/01/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Robotic surgery has been increasingly utilized, yet its application for hepato-pancreato-biliary (HPB) procedures remains low due to technical complexity, perceived financial burden, and unproven clinical benefits. We hypothesized that the robotic approach would be associated with improved clinical outcomes following major hepatectomy compared with the laparoscopic approach among elderly patients who would benefit from the advantages of minimally invasive surgery. METHODS A retrospective review of consecutive patients who underwent major hepatectomy between January 2010 and December 2021 at Carolinas Medical Center was performed. Inclusion criteria were age ≥ 65 years and major hepatectomy of three segments or more. Patients who underwent multiple liver resections, vascular/biliary reconstruction, or concomitant extrahepatic procedures (except cholecystectomy) were excluded. Categorical variables were compared using Chi-square or Fisher's exact test when more than 20% of cells had expected frequencies less than five, and Wilcoxon two-sample or Kruskal-Wallis tests were used for continuous or ordinal variables. Results are described as median and interquartile range (IQR). Multivariate analyses were used on postoperative admission days. RESULTS There were 399 major hepatectomies performed during this time period, of which 125 met the criteria and were included. There were no differences in perioperative demographics among patients who underwent robotic hepatectomy (RH, n = 39) and laparoscopic hepatectomy (LH, n = 32). There was no difference in operative time, blood loss, or major complication rates. However, RH had lower rates of conversion to an open procedure (2.6% versus 31.3%, p = 0.002), shorter length of hospital stay [LOS, 4 (3-7) versus 6 (4-8.5) days, p ≤ 0.0001], cumulative LOS [4 (3-7) versus 6 (4.5-9) days, p ≤ 0.0001], and lower rates of intensive care unit (ICU) admission (7.7% versus 75%, p ≤ 0.001), with a trend toward fewer rehabilitation requirements. CONCLUSIONS Robot major hepatectomy shows clinical advantages in elderly patients, including shorter hospital and ICU stays. These advantages, as well as reduced rehabilitation requirements associated with minimally invasive surgery, could overcome the current perceived financial disadvantages of robotic hepatectomy.
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Affiliation(s)
- Osamu Yoshino
- Division of HPB Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA.
- Division of HPB and Transplant Surgery, Department of Surgery, Austin Hospital, Victoria, Australia.
| | - Yifan Wang
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Frances McCarron
- Division of HPB Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Benjamin Motz
- Division of HPB Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Huaping Wang
- Division of Research, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Erin Baker
- Division of HPB Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - David Iannitti
- Division of HPB Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - John B Martinie
- Division of HPB Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Dionisios Vrochides
- Division of HPB Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
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21
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Fujiyama Y, Wakabayashi T, Mishima K, Al-Omari MA, Colella M, Wakabayashi G. Latest Findings on Minimally Invasive Anatomical Liver Resection. Cancers (Basel) 2023; 15:cancers15082218. [PMID: 37190146 DOI: 10.3390/cancers15082218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/19/2023] [Accepted: 03/25/2023] [Indexed: 05/17/2023] Open
Abstract
Minimally invasive liver resection (MILR) is being widely utilized owing to recent advancements in laparoscopic and robot-assisted surgery. There are two main types of liver resection: anatomical (minimally invasive anatomical liver resection (MIALR)) and nonanatomical. MIALR is defined as a minimally invasive liver resection along the respective portal territory. Optimization of the safety and precision of MIALR is the next challenge for hepatobiliary surgeons, and intraoperative indocyanine green (ICG) staining is considered to be of considerable importance in this field. In this article, we present the latest findings on MIALR and laparoscopic anatomical liver resection using ICG at our hospital.
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Affiliation(s)
- Yoshiki Fujiyama
- Department of Surgery, Ageo Central General Hospital, Saitama 362-8588, Japan
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama 362-8588, Japan
| | - Taiga Wakabayashi
- Department of Surgery, Ageo Central General Hospital, Saitama 362-8588, Japan
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama 362-8588, Japan
| | - Kohei Mishima
- Department of Surgery, Ageo Central General Hospital, Saitama 362-8588, Japan
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama 362-8588, Japan
- Institute for Research against Digestive Cancer (IRCAD), 67091 Strasbourg, France
| | - Malek A Al-Omari
- Department of Surgery, Ageo Central General Hospital, Saitama 362-8588, Japan
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama 362-8588, Japan
| | - Marco Colella
- Department of Surgery, Ageo Central General Hospital, Saitama 362-8588, Japan
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama 362-8588, Japan
| | - Go Wakabayashi
- Department of Surgery, Ageo Central General Hospital, Saitama 362-8588, Japan
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama 362-8588, Japan
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22
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Kajiwara M, Fujikawa T, Naito S, Sasaki T, Nakashima R, Hasegawa S. Non-Stick Liver Parenchymal Transection With Saline-Linked Bipolar Clamp-Crush Technique in Robotic Liver Resection. Cureus 2023; 15:e36401. [PMID: 37090277 PMCID: PMC10114974 DOI: 10.7759/cureus.36401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 04/25/2023] Open
Abstract
Background Without satisfactory instruments, liver parenchymal transection during robotic liver resection (RLR) remains challenging. We combined the commonly used bipolar clamp-crush technique with the saline drip, achieving a comfortable liver resection without coagulated liver tissues sticking to the bipolar forceps. Methods Between December 2022 and March 2023, six RLRs were performed using the saline-linked bipolar clamp-crush method for both anatomical and non-anatomical liver resections. We assessed the safety and feasibility of our robotic liver parenchymal transection technique. Results Three of six patients were diagnosed with colorectal liver metastasis, two with hepatocellular carcinoma (HCC), and the other with intrahepatic bile duct stricture. Three of the six patients received anatomical liver resection, and the other three underwent non-anatomical liver resection. There were no conversions to open surgery. The median operative time and estimated blood loss were 406.5 minutes (196-670 minutes) and 5 ml (5-465 ml), respectively. The median length of the postoperative hospital stay was nine days (7-10 days). Postoperative complications (Clavien-Dindo classification grade II or more) or mortality were not encountered in this cohort. Conclusion We presented here our saline-linked bipolar clamp-crush method for liver parenchymal transection in RLR. By simply adding the saline drip to the commonly used bipolar clamp-crush technique, non-stick and comfortable liver parenchymal transection is now possible. This technique may help overcome the limitations of currently available robotic instruments for liver parenchymal resection.
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Affiliation(s)
- Masatoshi Kajiwara
- Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| | | | - Shigetoshi Naito
- Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| | - Takahide Sasaki
- Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| | - Ryo Nakashima
- Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| | - Suguru Hasegawa
- Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
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Challenging Scenarios and Debated Indications for Laparoscopic Liver Resections for Hepatocellular Carcinoma. Cancers (Basel) 2023; 15:cancers15051493. [PMID: 36900284 PMCID: PMC10001345 DOI: 10.3390/cancers15051493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/19/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023] Open
Abstract
Laparoscopic liver resections (LLRs) have been increasingly adopted for the treatment of hepatocellular carcinoma (HCC), with safe short- and long-term outcomes reported worldwide. Despite this, lesions in the posterosuperior segments, large and recurrent tumors, portal hypertension, and advanced cirrhosis currently represent challenging scenarios in which the safety and efficacy of the laparoscopic approach are still controversial. In this systematic review, we pooled the available evidence on the short-term outcomes of LLRs for HCC in challenging clinical scenarios. All randomized and non-randomized studies reporting LLRs for HCC in the above-mentioned settings were included. The literature search was run in the Scopus, WoS, and Pubmed databases. Case reports, reviews, meta-analyses, studies including fewer than 10 patients, non-English language studies, and studies analyzing histology other than HCC were excluded. From 566 articles, 36 studies dated between 2006 and 2022 fulfilled the selection criteria and were included in the analysis. A total of 1859 patients were included, of whom 156 had advanced cirrhosis, 194 had portal hypertension, 436 had large HCCs, 477 had lesions located in the posterosuperior segments, and 596 had recurrent HCCs. Overall, the conversion rate ranged between 4.6% and 15.5%. Mortality and morbidity ranged between 0.0% and 5.1%, and 18.6% and 34.6%, respectively. Full results according to subgroups are described in the study. Advanced cirrhosis and portal hypertension, large and recurrent tumors, and lesions located in the posterosuperior segments are challenging clinical scenarios that should be carefully approached by laparoscopy. Safe short-term outcomes can be achieved provided experienced surgeons and high-volume centers.
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24
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Outcomes and Patient Selection in Laparoscopic vs. Open Liver Resection for HCC and Colorectal Cancer Liver Metastasis. Cancers (Basel) 2023; 15:cancers15041179. [PMID: 36831521 PMCID: PMC9954110 DOI: 10.3390/cancers15041179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
Hepatocellular carcinoma (HCC) and colorectal liver metastasis (CRLM) are the two most common malignant tumors that require liver resection. While liver transplantation is the best treatment for HCC, organ shortages and high costs limit the availability of this option for many patients and make resection the mainstay of treatment. For patients with CRLM, surgical resection with negative margins is the only potentially curative option. Over the last two decades, laparoscopic liver resection (LLR) has been increasingly adopted for the resection of a variety of tumors and was found to have similar long-term outcomes compared to open liver resection (OLR) while offering the benefits of improved short-term outcomes. In this review, we discuss the current literature on the outcomes of LLR vs. OLR for patients with HCC and CRLM. Although the use of LLR for HCC and CRLM is increasing, it is not appropriate for all patients. We describe an approach to selecting patients best-suited for LLR. The four common difficulty-scoring systems for LLR are summarized. Additionally, we review the current evidence behind the emerging robotically assisted liver resection technology.
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25
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Pure robotic major hepatectomy with biliary reconstruction for hepatobiliary malignancies: first European results. Surg Endosc 2023:10.1007/s00464-023-09863-5. [PMID: 36759354 DOI: 10.1007/s00464-023-09863-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/03/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Combined liver and bile duct resection with biliary reconstruction for hepatobiliary malignancies are defined as highly complex surgical procedures. The robotic platform may overcome some major limitations of conventional laparoscopic surgery for these complex cases but its precise role is however still to be defined. METHODS In our institution, patients requiring major hepatectomy with biliary reconstruction for malignancies were consecutively selected for minimally invasive robotic surgery from September 2020. All surgeries were undertaken using the da Vinci Xi Surgical System® (Intuitive Surgical, Sunnyvale, CA, USA). Intra-operative technique and postoperative outcome were analyzed. RESULTS A total number of 10 patients (3 males and 7 females, median age 72 years) underwent robotic major hepatectomy and bile duct resection for hepatobiliary malignancies between September 2020 and March 2022. The indication for surgery was perihilar cholangiocarcinoma in 5 of 10 patients. Median operative time was 338 min and median blood loss was 110 mL. Postoperative length of stay was between 3 and 16 days (median: 9 days). There was no postoperative 90-day mortality. CONCLUSIONS A robotic approach for hepatobiliary malignancies requiring combined major hepatectomy and bile duct resection seems feasible and safe in experienced hands.
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26
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D'Hondt M, Devooght A, Willems E, Wicherts D, De Meyere C, Parmentier I, Provoost A, Pottel H, Verslype C. Transition from laparoscopic to robotic liver surgery: clinical outcomes, learning curve effect, and cost-effectiveness. J Robot Surg 2023; 17:79-88. [PMID: 35322342 DOI: 10.1007/s11701-022-01405-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/16/2022] [Indexed: 12/30/2022]
Abstract
The reproducibility of the implementation of robotic liver surgery (RLS) is still debated. The aim of the present study is to evaluate short-term outcomes and cost differences during the implementation of RLS, performed by an early adopter in laparoscopic liver surgery (LLS). Patients undergoing RLS between February 2020 and May 2021 were included. Short-term outcomes of the robotic group (RG) were compared to the "Initial Phase" group (IP) of 120 LLS cases and the 120 most recent laparoscopic cases or "Mastery Phase" group (MP). A cost analysis per procedure for the three groups was performed. Seventy-one patients underwent RLS during the study period. Median operative time in the RG was comparable to the IP, but significantly shorter in the MP (140 vs 138 vs 120 min, p < 0.001). Median intraoperative blood loss in the RG was lower than in both laparoscopic groups (40 ml [20-90 ml] vs 150 ml [50-250 ml] vs 80 ml [30-150 ml], p < 0.001). Median hospital stay in the RG was significantly shorter than the IP group (p < 0.001). There were no significant differences in postoperative complication, conversion, or readmission rates. Procedural cost analysis was in favor of robotic surgery (€5008) compared to the IP (€ 6913) and the MP (€6099). Surgeons with sufficient experience in LLS can rapidly overcome the learning curve for RLS. In our experience, the short-term outcomes of the implementation phase of RLS are similar to the mastery phase of LLS. The total average cost per procedure is lower for RLS compared to LLS.
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Affiliation(s)
- M D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium.
| | - A Devooght
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium
| | - E Willems
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium
| | - D Wicherts
- Department of Abdominal Surgery, Hospital Oost-Limburg, Genk, Belgium
| | - C De Meyere
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium
| | - I Parmentier
- Department of Oncology and Statistics, Groeninge Hospital, Kortrijk, Belgium
| | - A Provoost
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium
| | - H Pottel
- Interdisciplinary Research Centre, Leuven University Campus Kortrijk, Kortrijk, Belgium
| | - C Verslype
- Department of Gastroenterology and Hepatology, KU Leuven, Leuven, Belgium
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27
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D'Hondt M, Wicherts DA. Robotic biliary surgery for benign and malignant bile duct obstruction: a case series. J Robot Surg 2023; 17:55-62. [PMID: 35312931 DOI: 10.1007/s11701-022-01392-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/18/2022] [Indexed: 11/29/2022]
Abstract
The majority of patients with benign or malignant biliary obstruction require surgical treatment with a bilio-enteric anastomosis. This requires fine dissection and advanced suturing. Robotic surgery may overcome some major limitations of conventional laparoscopic surgery. The precise role of robotic biliary surgery is, however, still to be defined. In our institution, patients requiring complex bile duct surgery were consecutively selected for minimally invasive robotic surgery from September 2020. All surgeries were undertaken using the da Vinci Xi Surgical System® (Intuitive Surgical, Sunnyvale, CA, USA). Intra-operative technique and postoperative outcome were analyzed. A total number of 14 patients underwent robotic biliary surgery for a variety of benign and malignant indications between September 2020 and May 2021. Six of fourteen patients (43%) had previous open abdominal surgery. Median blood loss was 25 mL (range 10-120 mL). There were no intra-operative complications and no conversions. Length of stay was between 3 and 11 days without major postoperative morbidity. Robotic surgery for benign and malignant bile duct obstruction is efficient and safe in experienced hands. Referral to a high-volume expert center is, however, advised.
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Affiliation(s)
- Mathieu D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium.
| | - Dennis A Wicherts
- Department of Abdominal and Hepatobiliary/Pancreatic Surgery, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
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28
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Robotic Left Trisectionectomy with Glissonian Approach (with Video). J Gastrointest Surg 2023; 27:842-844. [PMID: 36703020 DOI: 10.1007/s11605-023-05587-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/31/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Left hepatic trisectionectomy consists of the removal of liver segments 2, 3, 4, 5, and 8. This difficult surgical procedure may be required when the left liver and right anterior sector (segments 5 and 8) are involved. We present a video of a robotic anatomic left trisectionectomy with Glissonian approach to the left and right anterior sector pedicles. METHODS A 77-year-old man presented at a routine ultrasound with a large liver mass. Magnetic resonance imaging showed a bulky hepatocellular carcinoma occupying liver segments 2, 3, 4, 5, and 8, with a portal tumor thrombus in the right anterior sector. The patient had multiple comorbidities, including obesity, diabetes, hypertension, and coronariopathy. The multidisciplinary team decided to use immunotherapy with atezolizumab and bevacizumab. After 12 cycles, the patient showed an objective response, and left trisectionectomy was indicated. A robotic approach was proposed and consent was obtained. The Glissonian approach was used for anatomic control of the left and right anterior sector pedicles. RESULTS The operative time was 390 min with an estimated blood loss of 410 ml, and no transfusion was required during or after the procedure. Recovery was uneventful and the patient was discharged on postoperative day 8. No bile leak was observed, and the drain was removed on postoperative day 8. CONCLUSIONS Robotic left trisectionectomy is safe and feasible. The Glissonian approach is useful for anatomic left liver trisectionectomy. This video can help gastrointestinal surgeons perform this complex procedure in a minimally invasive manner.
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29
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Kato Y, Sugioka A, Kojima M, Kiguchi G, Mii S, Uchida Y, Takahara T, Uyama I. Initial experience with robotic liver resection: Audit of 120 consecutive cases at a single center and comparison with open and laparoscopic approaches. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2023; 30:72-90. [PMID: 35737850 DOI: 10.1002/jhbp.1206] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/09/2022] [Accepted: 06/03/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND/PURPOSE Surgical outcomes and utility of robotic liver resection (RLR) are undefined. METHODS We retrospectively studied perioperative and long-term outcomes of the single-center 120 RLRs including non-anatomic (NAR, n = 58) and anatomic (AR, n = 62) resections. To evaluate the feasibility and safety of RLR, perioperative outcomes of RLR (n = 103) were compared to those of open (OLR, n = 495) or laparoscopic (LLR, n = 451) resection in liver-only resections without reconstruction, using 1:1 propensity score matching (PSM). The changing trends from the earlier to the later RLR cases were assessed. Long-term outcomes were compared between RLR and LLR. RESULTS Various types of RLR with different surgical difficulties were performed, with mostly comparable postoperative morbidity between AR and NAR, or among AR subtypes. In segmentectomy and sectionectomy cases, perioperative outcomes significantly improved in the later period. In comparison between PSM-selected OLR and RLR cases (87:87), RLR had significantly longer operative time, less blood loss, and shorter hospital stay. PSM-selected LLR and RLR cases (91:91) showed comparable perioperative outcomes. Overall and recurrence-free survivals after RLR for newly diagnosed hepatocellular carcinoma and colorectal metastasis were comparable to those after LLR. CONCLUSIONS RLR is applicable to various types of liver resection with acceptable perioperative and long-term outcomes in select patients.
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Affiliation(s)
- Yutaro Kato
- Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, Toyoake, Japan
| | - Atsushi Sugioka
- International Medical Center, Fujita Health University Hospital, Toyoake, Japan
| | - Masayuki Kojima
- Department of Surgery, Fujita Health University, Toyoake, Japan
| | - Gozo Kiguchi
- Department of Surgery, Hirakata Kosai Hospital, Hirakata, Japan
| | - Satoshi Mii
- Department of Surgery, Fujita Health University, Toyoake, Japan
| | - Yuichiro Uchida
- Department of Surgery, Fujita Health University, Toyoake, Japan
| | | | - Ichiro Uyama
- Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, Toyoake, Japan
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Willems E, D'Hondt M, Kingham TP, Fuks D, Choi GH, Syn NL, Sucandy I, Marino MV, Prieto M, Chong CC, Lee JH, Efanov M, Chiow AKH, Choi SH, Sutcliffe RP, Troisi RI, Pratschke J, Cheung TT, Wang X, Tang CN, Liu R, Han HS, Goh BKP. Comparison Between Minimally Invasive Right Anterior and Right Posterior Sectionectomy vs Right Hepatectomy: An International Multicenter Propensity Score-Matched and Coarsened-Exact-Matched Analysis of 1,100 Patients. J Am Coll Surg 2022; 235:859-868. [PMID: 36102506 PMCID: PMC9720542 DOI: 10.1097/xcs.0000000000000394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The role of minimally invasive right anterior and right posterior sectionectomy (MI-RAS/MI-RPS) for right-sided liver lesions remains debatable. Although technically more demanding, these procedures might result in faster recovery and lower postoperative morbidity compared with minimally invasive right hemihepatectomy. STUDY DESIGN This is an international multicenter retrospective analysis of 1,114 patients undergoing minimally invasive right hemihepatectomy, MI-RAS, and MI-RPS at 21 centers between 2006 and 2019. Minimally invasive surgery included pure laparoscopic, robotic, hand-assisted, or a hybrid approach. A propensity-matched and coarsened-exact-matched analysis was performed. RESULTS A total of 1,100 cases met study criteria, of whom 759 underwent laparoscopic, 283 robotic, 11 hand-assisted, and 47 laparoscopic-assisted (hybrid) surgery. There were 632 right hemihepatectomies, 373 right posterior sectionectomies, and 95 right anterior sectionectomies. There were no differences in baseline characteristics after matching. In the MI-RAS/MI-RPS group, median blood loss was higher (400 vs 300 mL, p = 0.001) as well as intraoperative blood transfusion rate (19.6% vs 10.7%, p = 0.004). However, the overall morbidity rate was lower including major morbidity (7.1% vs 14.3%, p = 0.007) and reoperation rate (1.4% vs 4.6%, p = 0.029). The rate of close/involved margins was higher in the MI-RAS/MI-RPS group (23.4% vs 8.9%, p < 0.001). These findings were consistent after both propensity and coarsened-exact matching. CONCLUSIONS Although technically more demanding, MI-RAS/MI-RPS is a valuable alternative for minimally invasive right hemihepatectomy in right-sided liver lesions with lower postoperative morbidity, possibly due to the preservation of parenchyma. However, the rate of close/involved margins is higher in these procedures. These findings might guide surgeons in preoperative counselling and in selecting the appropriate procedure for their patients.
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Affiliation(s)
- Edward Willems
- From the Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium (Willems, D'Hondt)
| | - Mathieu D'Hondt
- From the Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium (Willems, D'Hondt)
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY (Kingham)
| | - David Fuks
- Department of Digestive, Oncologic and Metabolic Surgery, Institute Mutualiste Montsouris, Université Paris Descartes, Paris, France (Fuks)
| | - Gi-Hong Choi
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Choi)
| | - Nicholas L Syn
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore (Syn)
| | - Iswanto Sucandy
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore (Syn)
| | - Marco V Marino
- AdventHealth Tampa, Digestive Health Institute, Tampa, FL (Sucandy)
| | - Mikel Prieto
- General Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy (Marino)
| | - Charing C Chong
- Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (Chong)
| | - Jae Hoon Lee
- Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Lee)
| | - Mikhail Efanov
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia (Efanov)
| | - Adrian K H Chiow
- Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital, Singapore (Chiow)
| | - Sung Hoon Choi
- Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea (Choi)
| | - Robert P Sutcliffe
- Department of Hepatopancreatobiliary and Liver Transplant Surgery, University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom (Sutcliffe)
| | - Roberto I Troisi
- Department of Clinical Medicine and Surgery, Division of Hepatopancreatobiliary, Minimally Invasive and Robotic Surgery, Federico II University Hospital Naples, Naples, Italy (Troisi)
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin (Pratschke)
- Berlin Institute of Health, Berlin, Germany (Pratschke)
| | - Tan-To Cheung
- Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, China (Cheung)
| | - Xiaoying Wang
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China (Wang)
| | - Chung-Ngai Tang
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China (Tang)
| | - Rong Liu
- Faculty of Hepatopancreatobiliary Surgery, First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China (Liu)
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Hospital Bundang, Seoul National University College of Medicine, Seoul, Korea (Han)
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore (Goh)
- Duke-National University of Singapore Medical School, Singapore (Goh)
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Shapera E, Crespo K, Syblis C, Ross S, Rosemurgy A, Sucandy I. Robotic liver resection for hepatocellular carcinoma: analysis of surgical margins and clinical outcomes from a western tertiary hepatobiliary center. J Robot Surg 2022; 17:645-652. [PMID: 36271266 DOI: 10.1007/s11701-022-01468-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/10/2022] [Indexed: 10/24/2022]
Abstract
This study was undertaken to determine surgical outcomes of patients undergoing robotic hepatectomy for hepatocellular carcinoma (HCC) and to investigate the correlation between tumor distance to margin and perioperative outcomes, as well as overall survival (OS). To our knowledge, this study represents the largest series of robotic liver resection for HCC in North America. We retrospectively analyzed 58 consecutive patients who underwent robotic liver resection for HCC. Patients were further stratified by tumor distance to margin (≤ 1 mm, 1.1-9.9 mm, ≥ 10 mm) and their clinical outcomes including OS were compared. A majority of patients attained a greater than 1 mm tumor distance to margin (81%). There were no differences in tumor size between patient cohorts who attained ≤ 1 mm, 1.1-9.9 mm, and ≥ 10 mm margins. There were no differences in pre-, intra-, and postoperative outcomes among the three cohorts. Cost variables of interest were also similar. OS was highest in the > 10 mm margin cohort, and this was statistically significant at 3 and 5 years. Robotic HCC resection was associated with adequate tumor distance to margin. Wide margins ≥ 10 mm are associated with the best OS.
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Affiliation(s)
- Emanuel Shapera
- Digestive Health Institute, AdventHealth Tampa, 3000 Medical Park Drive, Suite 500, Tampa, FL, 33613, USA
| | - Kaitlyn Crespo
- Digestive Health Institute, AdventHealth Tampa, 3000 Medical Park Drive, Suite 500, Tampa, FL, 33613, USA
| | - Cameron Syblis
- Digestive Health Institute, AdventHealth Tampa, 3000 Medical Park Drive, Suite 500, Tampa, FL, 33613, USA
| | - Sharona Ross
- Digestive Health Institute, AdventHealth Tampa, 3000 Medical Park Drive, Suite 500, Tampa, FL, 33613, USA
| | - Alexander Rosemurgy
- Digestive Health Institute, AdventHealth Tampa, 3000 Medical Park Drive, Suite 500, Tampa, FL, 33613, USA
| | - Iswanto Sucandy
- Digestive Health Institute, AdventHealth Tampa, 3000 Medical Park Drive, Suite 500, Tampa, FL, 33613, USA.
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D’Silva M, Han HS, Liu R, Kingham TP, Choi GH, Syn NLX, Prieto M, Choi SH, Sucandy I, Chiow AKH, Marino MV, Efanov M, Lee JH, Sutcliffe RP, Chong CCN, Tang CN, Cheung TT, Pratschke J, Wang X, Park JO, Chan CY, Scatton O, Rotellar F, Troisi RI, D’Hondt M, Fuks D, Goh BKP, Gastaca M, Schotte H, De Meyere C, Lai EC, Krenzien F, Schmelzle M, Kadam P, Giglio M, Montalti R, Liu Q, Lee KF, Lee LS, Jang JY, Lim C, Labadie KP. Limited liver resections in the posterosuperior segments: international multicentre propensity score-matched and coarsened exact-matched analysis comparing the laparoscopic and robotic approaches. Br J Surg 2022; 109:1140-1149. [DOI: 10.1093/bjs/znac270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/22/2022] [Accepted: 07/14/2022] [Indexed: 12/07/2022]
Abstract
Abstract
Background
Limited liver resections (LLRs) for tumours located in the posterosuperior segments of the liver are technically demanding procedures. This study compared outcomes of robotic (R) and laparoscopic (L) LLR for tumours located in the posterosuperior liver segments (IV, VII, and VIII).
Methods
This was an international multicentre retrospective analysis of patients who underwent R-LLR or L-LLR at 24 centres between 2010 and 2019. Patient demographics, perioperative parameters, and postoperative outcomes were analysed; 1 : 3 propensity score matching (PSM) and 1 : 1 coarsened exact matching (CEM) were performed.
Results
Of 1566 patients undergoing R-LLR and L-LLR, 983 met the study inclusion criteria. Before matching, 159 R-LLRs and 824 L-LLRs were included. After 1 : 3 PSM of 127 R-LLRs and 381 L-LLRs, comparison of perioperative outcomes showed that median blood loss (100 (i.q.r. 40–200) versus 200 (100–500) ml; P = 0.003), blood loss of at least 500 ml (9 (7.4 per cent) versus 94 (27.6 per cent); P < 0.001), intraoperative blood transfusion rate (4 (3.1 per cent) versus 38 (10.0 per cent); P = 0.025), rate of conversion to open surgery (1 (0.8 per cent) versus 30 (7.9 per cent); P = 0.022), median duration of Pringle manoeuvre when applied (30 (20–46) versus 40 (25–58) min; P = 0.012), and median duration of operation (175 (130–255) versus 224 (155–300); P < 0.001) were lower in the R-LLR group compared with the L-LLR group. After 1 : 1 CEM of 104 R-LLRs with 104 L-LLRs, R-LLR was similarly associated with significantly reduced blood loss and a lower rate of conversion to open surgery.
Conclusion
Based on a matched analysis of well selected patients, both robotic and laparoscopic access could be undertaken safely with good outcomes for tumours in the posterosuperior liver segments.
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Affiliation(s)
- Mizelle D’Silva
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seoul , Korea
| | - Ho Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seoul , Korea
| | - Rong Liu
- Faculty of Hepatopancreatobiliary Surgery , First Medical Centre of Chinese People’s Liberation Army General Hospital, Beijing , China
| | - Thomas Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center , New York, New York , USA
| | - Gi Hong Choi
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine , Seoul , Korea
| | - Nicholas Li Xun Syn
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore , Singapore
| | - Mikel Prieto
- Hepatobiliary Surgery and Liver Transplantation Unit, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country , Bilbao , Spain
| | - Sung Hoon Choi
- Department of General Surgery, CHA Bundang Medical Centre, CHA University School of Medicine , Seongnam , Korea
| | - Iswanto Sucandy
- AdventHealth Tampa, Digestive Health Institute , Tampa, Florida , USA
| | - Adrian Kah Heng Chiow
- Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital , Singapore
| | - Marco Vito Marino
- General Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy and Oncologic Surgery Department, P. Giaccone University Hospital , Palermo , Italy
| | - Mikhail Efanov
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Centre , Moscow , Russia
| | - Jae Hoon Lee
- Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Asan Medical Centre, University of Ulsan College of Medicine , Seoul , Korea
| | - Robert Peter Sutcliffe
- Department of Hepatopancreatobiliary and Liver Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust , Birmingham , UK
| | - Charing Ching Ning Chong
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong , New Territories Hong Kong , China
| | - Chung Ngai Tang
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital , Hong Kong , China
| | - Tan To Cheung
- Department of Surgery, Queen Mary Hospital, University of Hong Kong , Hong Kong , China
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, and Berlin Institute of Health , Berlin , Germany
| | - Xiaoying Wang
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University , Shanghai , China
| | - James Oh Park
- Department of Surgery, University of Washington Medical Center and Fred Hutchinson Cancer Center, Seattle , Washington , USA
| | - Chung Yip Chan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and Duke-National University Singapore Medical School , Singapore
| | - Olivier Scatton
- Department of Digestive, Hepatobiliary–Pancreatic and Liver Transplantation, Hôpital Pitie-Salpetriere, AP-HP, Sorbonne Université , Paris , France
| | - Fernando Rotellar
- Hepatopancreatobiliary and Liver Transplant Unit, Department of General Surgery, Clinica Universidad de Navarra, Universidad de Navarra and Institute of Health Research of Navarra (IdisNA) , Pamplona , Spain
| | - Roberto Ivan Troisi
- Department of Clinical Medicine and Surgery, Division of Hepatopancreatobiliary, Minimally Invasive and Robotic Surgery, Federico II University Hospital Naples , Naples , Italy
| | - Mathieu D’Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital , Kortrijk , Belgium
| | - David Fuks
- Department of Digestive, Oncologic and Metabolic Surgery, Institute Mutualiste Montsouris, Universite Paris Descartes , Paris , France
| | - Brian Kim Poh Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and Duke-National University Singapore Medical School , Singapore
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Mima K, Nakagawa S, Miyata T, Yamashita Y, Baba H. Frailty and surgical outcomes in gastrointestinal cancer: Integration of geriatric assessment and prehabilitation into surgical practice for vulnerable patients. Ann Gastroenterol Surg 2022; 7:27-41. [PMID: 36643358 PMCID: PMC9831909 DOI: 10.1002/ags3.12601] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/27/2022] [Indexed: 01/18/2023] Open
Abstract
As life expectancy increases, the older population continues to grow rapidly, resulting in increased requirement for surgery for older patients with gastrointestinal cancer. Older individuals represent a heterogeneous group in terms of physiological reserves, co-morbidity, cognitive impairment, and disability. Owing to the lack of treatment guidelines for vulnerable patients with gastrointestinal cancer, these patients are more likely to be at risk of undertreatment or overtreatment. Hence, the identification of frail patients with gastrointestinal cancer would improve cancer treatment outcomes. Although there is no standardized geriatric assessment tool, a growing body of research has shown associations of frailty with adverse postoperative outcomes and poor prognosis after resection of gastrointestinal tract and hepatobiliary-pancreatic cancers. Emerging evidence suggests that prehabilitation, which includes exercise and nutritional support, can improve preoperative functional capacity, postoperative recovery, and surgical outcomes, particularly in frail patients with gastrointestinal cancer. We reviewed major geriatric assessment tools for identification of frail patients and summarized clinical studies on frailty and surgical outcomes, as well as prehabilitation or rehabilitation in gastrointestinal tract and hepatobiliary-pancreatic cancers. The integration of preoperative geriatric assessment and prehabilitation of frail patients in clinical practice may improve surgical outcomes. In addition, improving preoperative vulnerability and preventing functional decline after surgery is important in providing favorable long-term survival in patients with gastrointestinal cancer. Further clinical trials are needed to examine the effects of minimally invasive surgery, and chemotherapy in frail patients with gastrointestinal cancer.
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Affiliation(s)
- Kosuke Mima
- Department of Gastroenterological Surgery, Graduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Shigeki Nakagawa
- Department of Gastroenterological Surgery, Graduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Tatsunori Miyata
- Department of Gastroenterological Surgery, Graduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Yo‐ichi Yamashita
- Department of Gastroenterological Surgery, Graduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical SciencesKumamoto UniversityKumamotoJapan
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Schmelzle M, Feldbrügge L, Ortiz Galindo SA, Moosburner S, Kästner A, Krenzien F, Benzing C, Biebl M, Öllinger R, Malinka T, Schöning W, Pratschke J. Robotic vs. laparoscopic liver surgery: a single-center analysis of 600 consecutive patients in 6 years. Surg Endosc 2022; 36:5854-5862. [PMID: 35641702 PMCID: PMC9283354 DOI: 10.1007/s00464-021-08770-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 10/09/2021] [Indexed: 11/24/2022]
Abstract
Background While laparoscopic liver surgery has become a standard procedure, experience with robotic liver surgery is still limited. The aim of this prospective study was to evaluate safety and feasibility of robotic liver surgery and compare outcomes with conventional laparoscopy. Methods We here report the results of a single-center, prospective, post-marketing observational study (DRKS00017229) investigating the safety and feasibility of robotic liver surgery. Baseline characteristics, surgical complexity (using the IWATE score), and postoperative outcomes were then compared to laparoscopic liver resections performed at our center between January 2015 and December 2020. A propensity score-based matching (PSM) was applied to control for selection bias. Results One hundred twenty nine robotic liver resections were performed using the da Vinci Xi surgical system (Intuitive) in this prospective study and were compared to 471 consecutive laparoscopic liver resections. After PSM, both groups comprised 129 cases with similar baseline characteristics and surgical complexity. There were no significant differences in intraoperative variables, such as need for red blood cell transfusion, duration of surgery, or conversion to open surgery. Postoperative complications were comparable after robotic and laparoscopic surgery (Clavien–Dindo ≥ 3a: 23% vs. 19%, p = 0.625); however, there were more bile leakages grade B–C in the robotic group (17% vs. 7%, p = 0.006). Length of stay and oncological short-term outcomes were comparable. Conclusions We propose robotic liver resection as a safe and feasible alternative to established laparoscopic techniques. The object of future studies must be to define interventions where robotic techniques are superior to conventional laparoscopy.
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Affiliation(s)
- Moritz Schmelzle
- Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Linda Feldbrügge
- Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Santiago Andres Ortiz Galindo
- Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Simon Moosburner
- Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Anika Kästner
- Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Felix Krenzien
- Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Christian Benzing
- Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Matthias Biebl
- Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Robert Öllinger
- Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Thomas Malinka
- Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Wenzel Schöning
- Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
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Shapera EA, Ross S, Syblis C, Crespo K, Rosemurgy A, Sucandy I. Analysis of Oncological Outcomes After Robotic Liver Resection for Intrahepatic Cholangiocarcinoma. Am Surg 2022:31348221093933. [PMID: 35512632 DOI: 10.1177/00031348221093933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Concerns regarding minimally invasive liver resection of intrahepatic cholangiocarcinoma (IHCC) include inadequate resection margins and inferior long-term overall survival (OS) when compared to an "open" approach. Limited data exists to address these issues. We aimed to compare perioperative variables, tumor distance to margin, and long-term outcomes after IHCC resection based on surgical approach (robotic vs open) in our hepatobiliary center to address these concerns. METHODS With IRB approval, 34 patients who underwent robotic or open hepatectomy for IHCC were prospectively followed. Patients were stratified by tumor distance to resection margin (≤1 mm, 1.1-9.9 mm, ≥10 mm) for illustrative purposes and by approach (robotic vs open). Where appropriate, regression analysis and cox model of proportional hazards were utilized. Survival was stratified by margin distance and approach utilizing Kaplan-Meier curves. Data are presented as median (mean ± SD). RESULTS Patients undergoing robotic vs open hepatectomy had similar demographics. Patients undergoing the robotic approach had significantly lower estimated blood loss (EBL). Tumor distance to margin between the two approaches were similar (P = .428). Median OS between the two approaches was similar in patients of any margin distance.In the subgroup analysis by margin distance, the robotic approach yielded less EBL for patients in the 1.1-9.9 mm and ≥10 mm margin groups, and a shorter ICU length of stay for patients with ≥10 mm margin. DISCUSSION Similar margins were attained via either approach, translating into oncological non-inferiority of robotic IHCC resection. Robotic approach for the treatment of IHCC should be considered an alternative to an open approach.
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Affiliation(s)
- Emanuel A Shapera
- Center for Advanced Minimally Invasive Liver Surgery, Digestive Health Institute, 4422AdventHealth Tampaa, Tampa, FL, USA
| | - Sharona Ross
- Center for Advanced Minimally Invasive Liver Surgery, Digestive Health Institute, 4422AdventHealth Tampaa, Tampa, FL, USA
| | - Cameron Syblis
- Center for Advanced Minimally Invasive Liver Surgery, Digestive Health Institute, 4422AdventHealth Tampaa, Tampa, FL, USA
| | - Kaitlyn Crespo
- Center for Advanced Minimally Invasive Liver Surgery, Digestive Health Institute, 4422AdventHealth Tampaa, Tampa, FL, USA
| | - Alexander Rosemurgy
- Center for Advanced Minimally Invasive Liver Surgery, Digestive Health Institute, 4422AdventHealth Tampaa, Tampa, FL, USA
| | - Iswanto Sucandy
- Center for Advanced Minimally Invasive Liver Surgery, Digestive Health Institute, 4422AdventHealth Tampaa, Tampa, FL, USA
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Ayabe RI, Azimuddin A, Tran Cao HS. Robot-assisted liver resection: the real benefit so far. Langenbecks Arch Surg 2022; 407:1779-1787. [PMID: 35488913 DOI: 10.1007/s00423-022-02523-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/19/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Minimally invasive liver resection is associated with lower perioperative morbidity and shorter hospital stay. However, the added benefit of the robotic platform over conventional laparoscopy is a matter of ongoing investigation. PURPOSE The purpose of this narrative review is to provide an up-to-date and balanced evaluation of the benefits and shortcomings of robotic liver surgery for the modern hepatobiliary surgeon. CONCLUSIONS Advantages of a robotic approach to liver resection include a shortened learning curve, the ability to complete more extensive or complex minimally invasive operations, and integrated fluorescence guidance. However, the robotic platform remains limited by a paucity of parenchymal transection devices, complete lack of haptic feedback, and added operating time associated with docking and instrument exchange. Like laparoscopic hepatectomy, robotic hepatectomy may provide patients with more rapid recovery and a shorter hospital stay, which can help offset the substantial costs of robot acquisition and maintenance. The oncologic outcomes of robotic hepatectomy appear to be equivalent to laparoscopic and open hepatectomy for appropriately selected patients.
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Affiliation(s)
- Reed I Ayabe
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1484, Houston, TX, 77030, USA
| | - Ahad Azimuddin
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1484, Houston, TX, 77030, USA
| | - Hop S Tran Cao
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1484, Houston, TX, 77030, USA.
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Han DH. Current status of robotic surgery for liver transplantation. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2022. [DOI: 10.18528/ijgii220010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Dai Hoon Han
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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Yang HY, Choi GH, Chin KM, Choi SH, Syn NL, Cheung TT, Chiow AKH, Sucandy I, Marino MV, Prieto M, Chong CC, Lee JH, Efanov M, Kingham TP, Sutcliffe RP, Troisi RI, Pratschke J, Wang X, D’Hondt M, Tang CN, Liu R, Park JO, Rotellar F, Scatton O, Sugioka A, Long TCD, Chan CY, Fuks D, Han HS, Goh BKP. Robotic and laparoscopic right anterior sectionectomy and central hepatectomy: multicentre propensity score-matched analysis. Br J Surg 2022; 109:311-314. [PMID: 35139157 PMCID: PMC8981979 DOI: 10.1093/bjs/znab463] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 11/04/2021] [Accepted: 12/14/2021] [Indexed: 12/30/2022]
Abstract
Both robotic and laparoscopic right anterior sectionectomy and central hepatectomy can be performed safely in expert centres, with excellent outcomes. The robotic approach was associated with statistically significant less blood loss compared with laparoscopy, although the clinical relevance of this finding remains unclear.
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Affiliation(s)
- Hye Yeon Yang
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Gi Hong Choi
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ken-Min Chin
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - Sung Hoon Choi
- Department of General Surgery, CHA Bundang Medical Centre, CHA University School of Medicine, Seongnam, Korea
| | - Nicholas L. Syn
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tan-To Cheung
- Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Adrian K. H. Chiow
- Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital, Singapore
| | - Iswanto Sucandy
- AdventHealth Tampa, Digestive Health Institute, Tampa, Florida, USA
| | - Marco V. Marino
- General Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
- Oncologic Surgery Department, P. Giaccone University Hospital, Palermo, Italy
| | - Mikel Prieto
- Hepatobiliary Surgery and Liver Transplantation Unit, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
| | - Charing C. Chong
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, New Territories, Hong Kong, China
| | - Jae Hoon Lee
- Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | - Mikhail Efanov
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Centre, Moscow, Russia
| | - T. Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Robert P. Sutcliffe
- Department of Hepatopancreatobiliary and Liver Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Roberto I. Troisi
- Department of Clinical Medicine and Surgery, Division of Hepato-Pancreato-Biliary, Minimally Invasive and Robotic Surgery, Federico II University Hospital Naples, Naples, Italy
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Xiaoying Wang
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mathieu D’Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Chung Ngai Tang
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Rong Liu
- Faculty of Hepatopancreatobiliary Surgery, First Medical Centre of Chinese People’s Liberation Army General Hospital, Beijing, China
| | - James O. Park
- Hepatobiliary Surgical Oncology, Department of Surgery, University of Washington Medical Center, Seattle, Washington, USA
| | - Fernando Rotellar
- Hepatopancreatobiliary and Liver Transplant Unit, Department of General Surgery, Clinica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain
- Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
| | - Olivier Scatton
- Department of Digestive, Hepato-biliary-pancreatic and Liver Transplantation, Hôpital Pitie-Salpetriere, AP-HP, Sorbonne Université, Paris, France
| | - Atsushi Sugioka
- Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan
| | - Tran Cong Duy Long
- Department of Hepatopancreatobiliary Surgery, University Medical Center, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Chung-Yip Chan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and Duke National University of Singapore Medical School, Singapore
| | - David Fuks
- Department of Digestive, Oncologic and Metabolic Surgery, Institute Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Brian K. P. Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and Duke National University of Singapore Medical School, Singapore
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Masetti M, Fallani G, Ratti F, Ferrero A, Giuliante F, Cillo U, Guglielmi A, Ettorre GM, Torzilli G, Vincenti L, Ercolani G, Cipressi C, Lombardi R, Aldrighetti L, Jovine E. Minimally invasive treatment of colorectal liver metastases: does robotic surgery provide any technical advantages over laparoscopy? A multicenter analysis from the IGoMILS (Italian Group of Minimally Invasive Liver Surgery) registry. Updates Surg 2022; 74:535-545. [DOI: 10.1007/s13304-022-01245-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 01/15/2022] [Indexed: 12/27/2022]
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Durán M, Briceño J, Padial A, Anelli FM, Sánchez-Hidalgo JM, Ayllón MD, Calleja-Lozano R, García-Gaitan C. Short-term outcomes of robotic liver resection: An initial single-institution experience. World J Hepatol 2022; 14:224-233. [PMID: 35126850 PMCID: PMC8790404 DOI: 10.4254/wjh.v14.i1.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 12/02/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Liver surgery has traditionally been characterized by the complexity of its procedures and potentially high rates of morbidity and mortality in inexperienced hands. The robotic approach has gradually been introduced in liver surgery and has increased notably in recent years. However, few centers currently perform robotic liver surgery and experiences in robot-assisted surgical procedures continue to be limited compared to the laparoscopic approach.
AIM To analyze the outcomes and feasibility of an initial robotic liver program implemented in an experienced laparoscopic hepatobiliary center.
METHODS A total of forty consecutive patients underwent robotic liver resection (da Vinci Xi, intuitive.com, United States) between June 2019 and January 2021. Patients were prospectively followed and retrospectively reviewed. Clinicopathological characteristics and perioperative and short-term outcomes were analyzed. Data are expressed as mean and standard deviation. The study was approved by the Institutional Review Board.
RESULTS The mean age of patients was 59.55 years, of which 18 (45%) were female. The mean body mass index was 29.41 kg/m². Nine patients (22.5%) were cirrhotic. Patients were divided by type of resection as follows: Ten segmentectomies, three wedge resections, ten left lateral sectionectomies, six bisegmentectomies (two V-VI bisegmentectomies and four IVb-V bisegmentectomies), two right anterior sectionectomies, five left hepatectomies and two right hepatectomies. Malignant lesions occurred in twenty-nine (72.5%) of the patients. The mean operative time was 258.11 min and two patients were transfused intraoperatively (5%). Inflow occlusion was used in thirty cases (75%) and the mean total clamping time was 32.62 min. There was a single conversion due to uncontrollable hemorrhage. Major postoperative complications (Clavien–Dindo > IIIb) occurred in three patients (7.5%) and mortality in one (2.5%). No patient required readmission to the hospital. The mean hospital stay was 5.6 d.
CONCLUSION Although robotic hepatectomy is a safe and feasible procedure with favorable short-term outcomes, it involves a demanding learning curve that requires a high level of training, skill and dexterity.
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Affiliation(s)
- Manuel Durán
- Unit of Hepatobiliary Surgery and Liver Transplantation, General and Digestive Surgery Department, Reina Sofia University Hospital, Cordoba 14004, Spain
- GC18 Translational Research in Surgery of Solid Organ Transplantation, Maimonides Biomedical Research Institute, Córdoba 14004, Spain
| | - Javier Briceño
- Unit of Hepatobiliary Surgery and Liver Transplantation, General and Digestive Surgery Department, Reina Sofia University Hospital, Cordoba 14004, Spain
- GC18 Translational Research in Surgery of Solid Organ Transplantation, Maimonides Biomedical Research Institute, Córdoba 14004, Spain
| | - Ana Padial
- Unit of Hepatobiliary Surgery and Liver Transplantation, General and Digestive Surgery Department, Reina Sofia University Hospital, Cordoba 14004, Spain
- GC18 Translational Research in Surgery of Solid Organ Transplantation, Maimonides Biomedical Research Institute, Córdoba 14004, Spain
| | - Ferdinando Massimiliano Anelli
- Unit of Hepatobiliary Surgery and Liver Transplantation, General and Digestive Surgery Department, Reina Sofia University Hospital, Cordoba 14004, Spain
- GC18 Translational Research in Surgery of Solid Organ Transplantation, Maimonides Biomedical Research Institute, Córdoba 14004, Spain
| | - Juan Manuel Sánchez-Hidalgo
- Unit of Hepatobiliary Surgery and Liver Transplantation, General and Digestive Surgery Department, Reina Sofia University Hospital, Cordoba 14004, Spain
- GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical Research Institute, Córdoba 14004, Spain
| | - María Dolores Ayllón
- Unit of Hepatobiliary Surgery and Liver Transplantation, General and Digestive Surgery Department, Reina Sofia University Hospital, Cordoba 14004, Spain
- GC18 Translational Research in Surgery of Solid Organ Transplantation, Maimonides Biomedical Research Institute, Córdoba 14004, Spain
| | - Rafael Calleja-Lozano
- Unit of Hepatobiliary Surgery and Liver Transplantation, General and Digestive Surgery Department, Reina Sofia University Hospital, Cordoba 14004, Spain
- GC18 Translational Research in Surgery of Solid Organ Transplantation, Maimonides Biomedical Research Institute, Córdoba 14004, Spain
| | - Carmen García-Gaitan
- Department of Anesthesiology and Resuscitation, Reina Sofia University Hospital, Cordoba 14004, Spain
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Spiegelberg J, Iken T, Diener MK, Fichtner-Feigl S. Robotic-Assisted Surgery for Primary Hepatobiliary Tumors-Possibilities and Limitations. Cancers (Basel) 2022; 14:cancers14020265. [PMID: 35053429 PMCID: PMC8773643 DOI: 10.3390/cancers14020265] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/26/2021] [Accepted: 01/05/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Primary liver malignancies are some of the most common and fatal tumors today. Robotic-assisted liver surgery is becoming increasingly interesting for both patients and surgeons alike. Up to date, prospective comparative studies around the topic are scarce. This leads us to an ever existing controversy about the efficacy, safety, and economic benefits of robotic surgery as an extension of traditional minimally invasive surgery over open liver surgery. However, there is evidence that robotic-assisted surgery is, after passing the learning curve, equivalent in terms of feasibility and safety, and in some cases superior to traditional laparoscopic hepatic resection. With this work, we want to provide an overview of the latest and most significant reviews and meta-analyses focusing on robotic hepatectomy in primary liver malignancies. We outline the technical aspects of robotic-assisted surgery and place them into the context of technical, surgical, and oncological outcomes compared with laparoscopic and open resection. When chosen per case individually, any hepatic resection can be performed robotically to overcome limitations of laparoscopic surgery by an experienced team. In this paper, we propose that prospective studies are needed to prove efficacy for robotic-assisted resection in liver malignancy. Abstract Hepatocellular and cholangiocellular carcinoma are fatal primary hepatic tumors demanding extensive liver resection. Liver surgery is technically challenging due to the complex liver anatomy, with an intensive and variant vascular and biliary system. Therefore, major hepatectomies in particular are often performed by open resection and minor hepatectomies are often performed minimally invasively. More centers have adopted robotic-assisted surgery, intending to improve the laparoscopic surgical limits, as it offers some technical benefits such as seven degrees of freedom and 3D visualization. The da Vinci® Surgical System has dominated the surgical robot market since 2000 and has shown surgical feasibility, but there is still much controversy about its economic benefits and real benefits for the patient over the gold standard. The currently available retrospective case studies are difficult to compare, and larger, prospective studies and randomized trials are still urgently missing. Therefore, here we summarize the technical, surgical, and economic outcomes of robotic versus open and laparoscopic hepatectomies for primary liver tumors found in the latest literature reviews and meta-analyses. We conclude that complex robotic liver resections (RLR) are safe and feasible after the steep learning curve of the surgical team has plateaued. The financial burden is lower in high volume centers and is expected to decrease soon as new surgical systems will enter the market.
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Delvecchio A, Inchingolo R, Laforgia R, Ratti F, Gelli M, Anelli MF, Laurent A, Vitali G, Magistri P, Assirati G, Felli E, Wakabayashi T, Pessaux P, Piardi T, di Benedetto F, de'Angelis N, Briceño J, Rampoldi A, Adam R, Cherqui D, Aldrighetti LA, Memeo R. Liver resection vs radiofrequency ablation in single hepatocellular carcinoma of posterosuperior segments in elderly patients. World J Gastrointest Surg 2021; 13:1696-1707. [PMID: 35070074 PMCID: PMC8727180 DOI: 10.4240/wjgs.v13.i12.1696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/30/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Liver resection and radiofrequency ablation are considered curative options for hepatocellular carcinoma. The choice between these techniques is still controversial especially in cases of hepatocellular carcinoma affecting posterosuperior segments in elderly patients.
AIM To compare post-operative outcomes between liver resection and radiofrequency ablation in elderly with single hepatocellular carcinoma located in posterosuperior segments.
METHODS A retrospective multicentric study was performed enrolling 77 patients age ≥ 70-years-old with single hepatocellular carcinoma (≤ 30 mm), located in posterosuperior segments (4a, 7, 8). Patients were divided into liver resection and radiofrequency ablation groups and preoperative, peri-operative and long-term outcomes were retrospectively analyzed and compared using a 1:1 propensity score matching.
RESULTS After propensity score matching, twenty-six patients were included in each group. Operative time and overall postoperative complications were higher in the resection group compared to the ablation group (165 min vs 20 min, P < 0.01; 54% vs 19% P = 0.02 respectively). A median hospital stay was significantly longer in the resection group than in the ablation group (7.5 d vs 3 d, P < 0.01). Ninety-day mortality was comparable between the two groups. There were no significant differences between resection and ablation group in terms of overall survival and disease free survival at 1, 3, and 5 years.
CONCLUSION Radiofrequency ablation in posterosuperior segments in elderly is safe and feasible and ensures a short hospital stay, better quality of life and does not modify the overall and disease-free survival.
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Affiliation(s)
- Antonella Delvecchio
- Unit of General Surgery, "A. Perrino" Hospital, Ceglie Messapica 70124, Bari, Italy
| | - Riccardo Inchingolo
- Interventional Radiology Unit, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 75100, Italy
| | - Rita Laforgia
- Unit of Laparoscopic Surgery, University of Bari, Bary 70124, Italy
| | - Francesca Ratti
- Unit of Hepato-Pancreatic-Biliary Surgery, University Vita Salute San Raffaele, Milan 20132, Italy
| | - Maximiliano Gelli
- Department of Surgical Oncology, Gustave Roussy Cancer Campus Grand Paris, Villejuif 94800, France
| | | | - Alexis Laurent
- Department of Digestive and Hepatobiliary Surgery, Henry Mondor University Hospital, Creteil 94000, France
| | - Giulio Vitali
- Division of Transplantation, Geneva University Hospital, Geneva 44041, Switzerland
| | - Paolo Magistri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena 42121, Italy
| | - Giacomo Assirati
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena 42121, Italy
| | - Emanuele Felli
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg 67000, France
| | - Taiga Wakabayashi
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg 67000, France
| | - Patrick Pessaux
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg 67000, France
| | - Tullio Piardi
- Department of Digestive and Hepatobiliary Surgery, Robert Debrè University Hospital, Reims 51100, France
| | - Fabrizio di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena 42121, Italy
| | - Nicola de'Angelis
- Unit of Minimally Invasive and Robotic Digestive Surgery, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70124, Italy
| | - Javier Briceño
- Department of General Surgery, Reina Sofia University Hospital, Cordoba 14004, Spain
| | - Antonio Rampoldi
- Interventional Radiology Unit, Niguarda Hospital, Milan 20162, Italy
| | - Renè Adam
- Department of Hepatobiliary Surgery, Paul Brousse University Hospital, Villejuif 94800, France
| | - Daniel Cherqui
- Department of Hepatobiliary Surgery, Paul Brousse University Hospital, Villejuif 94800, France
| | | | - Riccardo Memeo
- Unit of Hepato-Pancreatic-Biliary Surgery, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70124, Italy
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Zhu L, Liu Y, Hu M, Zhao Z, Li C, Zhang X, Tan X, Wang F, Liu R. Comparison of robotic and laparoscopic liver resection in ordinary cases of left lateral sectionectomy. Surg Endosc 2021; 36:4923-4931. [PMID: 34750706 DOI: 10.1007/s00464-021-08846-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 10/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Laparoscopy was considered the standard method of left lateral sectionectomy. The robotic approach showed advantages in complex cases of left lateral sectionectomy. However, the impact of the robotic system on ordinary cases is still unknown. METHODS Retrospective review of consecutive robotic left lateral sectionectomy (R-LLS) and laparoscopic left lateral sectionectomy (L-LLS) from January 2015 to December 2019. Univariate and multivariate logistic regression was used to determine the effects of surgical method and surgical complexity on postoperative length of stay, surgical and overall cost. RESULTS 258 consecutive patients who underwent minimally invasive left lateral sectionectomy were analyzed. L-LLS had comparable outcomes and decreased surgery (USD 2416.3 vs 4624.5; p < 0.001) and overall costs (USD 8004.5 vs 11897.1; p < 0.001) compared with R-LLS in the ordinary-case group, whereas R-LLS was associated with shorter postoperative LOS (5.0 vs 3.5 days; p = 0.004) in the complex-case group. On multivariable analysis, R-LLS was predictive of shorter postoperative LOS [odds ratio (OR) 0.388, 95% confidence interval (CI) 0.198-0.760, p = 0.006], whereas R-LLS was predictive of higher surgery (OR 65.640, 95% CI 17.406-247.535, p < 0.001) and overall costs (OR 102.233, 95% CI 22.241-469.931, p < 0.001). CONCLUSION Results of this study showed no clinical benefit to the R-LLS compared with L-LLS in ordinary cases. R-LLS had potential advantages in selected complex cases.
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Affiliation(s)
- Lin Zhu
- The First School of Clinical Medicine, Lanzhou University, No. 1, Donggangxi Rd, Chengguan District, Lanzhou, 730000, Gansu, China.,Department of Hepatopancreatobiliary Surgery, The General Hospital of People's Liberation Army, 28 Fuxing Road, Beijing, 100853, China
| | - Yanzhe Liu
- Department of Hepatopancreatobiliary Surgery, The General Hospital of People's Liberation Army, 28 Fuxing Road, Beijing, 100853, China
| | - Minggen Hu
- Department of Hepatopancreatobiliary Surgery, The General Hospital of People's Liberation Army, 28 Fuxing Road, Beijing, 100853, China
| | - Zhiming Zhao
- Department of Hepatopancreatobiliary Surgery, The General Hospital of People's Liberation Army, 28 Fuxing Road, Beijing, 100853, China
| | - Chenggang Li
- Department of Hepatopancreatobiliary Surgery, The General Hospital of People's Liberation Army, 28 Fuxing Road, Beijing, 100853, China
| | - Xuan Zhang
- Department of Hepatopancreatobiliary Surgery, The General Hospital of People's Liberation Army, 28 Fuxing Road, Beijing, 100853, China
| | - Xianglong Tan
- Department of Hepatopancreatobiliary Surgery, The General Hospital of People's Liberation Army, 28 Fuxing Road, Beijing, 100853, China
| | - Fei Wang
- Department of Hepatopancreatobiliary Surgery, The General Hospital of People's Liberation Army, 28 Fuxing Road, Beijing, 100853, China
| | - Rong Liu
- The First School of Clinical Medicine, Lanzhou University, No. 1, Donggangxi Rd, Chengguan District, Lanzhou, 730000, Gansu, China. .,Department of Hepatopancreatobiliary Surgery, The General Hospital of People's Liberation Army, 28 Fuxing Road, Beijing, 100853, China.
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Sucandy I, Ross SB, Crespo KL, Rosemurgy AS. Robotic Extrahepatic Biliary Resection with Roux-en-Y Hepaticojejunostomy for Type 2 Klatskin Tumor. Ann Surg Oncol 2021; 29:339-340. [PMID: 34370140 DOI: 10.1245/s10434-021-10562-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 07/18/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Despite the widespread of laparoscopic technique in hepatobiliary tumor resection, nearly all Klatskin tumor resection is undertaken using an open approach (Marino et al. in Updates Surg 72(3):911-912. https://doi.org/10.1007/s13304-020-00777-8 ; Sucandy et al. in Am Surg, 2020. https://doi.org/10.1177/0003134820956336 , Am Surg, 2020;86(3):200-207; Luberice et al. in HPB (Oxford), 2020. https://doi.org/10.1016/j.hpb.2020.10.008 ; Ciria et al. in J Hepatobiliary Pancreat Sci, 2020. https://doi.org/10.1002/jhbp.869 ; Chong and Choi in J Gastrointest Surg 23(9):1947-19488, 2019. https://doi.org/10.1007/s11605-019-04242-9 ). A minimally invasive approach for malignant extrahepatic biliary resection is rarely used due to technical complexity and concerns of oncological inferiority. In the United States, robotic technique for Klatskin tumor resection has not been adequately described. This video described our technique of robotic extrahepatic biliary resection with Roux-en-Y hepaticojejunostomy (HJ) for type 2 Klatskin tumor. METHODS A 77-year-old man presented with obstructive jaundice. Endobiliary brushing confirmed adenocarcinoma. MRI/MRCP showed a focal lesion at the cystic duct entrance into the common hepatic duct, extending cephalad toward the biliary bifurcation. No obvious vascular invasion was identified on the CT scan. RESULTS The operation was undertaken using a six-port technique. Systematic portal dissection was undertaken to identify the bile duct at the level of the pancreas up toward the hepatic hilum. A partial Kocher maneuver was performed to expose the area dorsal to the distal common bile duct, which allows for a more thorough lymphadenectomy and facilitates creation of a later tension-free hepaticojejunostomy. The distal common bile duct was transected, and the distal margin was sent for frozen section. The right hepatic artery coursing posterior to the common hepatic duct was skeletonized and preserved. Biliary duct bifurcation was transected at the level of the right and left duct, removing the cancer completely. Portal lymphadenectomy was completed as part of oncological staging and treatment. A total of eight lymph nodes were removed and all confirmed to be nonneoplastic on the final pathology report. For the purpose of the biliary reconstruction, a standard side-to-side stapled jejunojejunostomy was created. A jejunal mesenteric defect was closed to prevent a future internal herniation. A 60-cm Roux limb was transposed antecolically for the Roux-en-Y hepaticojejunostomy. A running technique was used to create a watertight end-to-side bilioenteric anastomosis, using 3-0 barbed sutures, 6 inches in length. A closed suction drain was placed before closing. Pathology report confirmed intraductal papillary adenocarcinoma with R-0 resection margins (proximal, distal, and radial margin). Perineural invasion was present; however, lymphovascular invasion was not identified. Total operative time was 240 minutes with 75 ml of estimated blood loss. The postoperative recovery was uneventful. One-year follow-up showed no evidence of disease recurrence or HJ anastomotic stricture. CONCLUSIONS This video demonstrates a safe and feasible application of the robotic platform in extrahepatic bile duct cancer resection requiring fine biliary reconstruction.
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Affiliation(s)
- Iswanto Sucandy
- Digestive Health Institute, AdventHealth Tampa, Tampa, FL, USA.
| | - Sharona B Ross
- Digestive Health Institute, AdventHealth Tampa, Tampa, FL, USA
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Modasi A, Sucandy I, Ross S, Krill E, Castro M, Lippert T, Luberice K, Rosemurgy A. The effect of diabetes on major robotic hepatectomy. J Robot Surg 2021; 16:137-142. [PMID: 33682066 DOI: 10.1007/s11701-021-01223-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 02/28/2021] [Indexed: 11/27/2022]
Abstract
Studies regarding the influence of diabetes on perioperative outcomes after major hepatectomy are conflicting. The objective of this study is to analyze the effects of diabetes on patients undergoing robotic major hepatectomy. With Institutional Review Board (IRB) approval, 94 patients undergoing major hepatectomy were prospectively followed. Demographic data and postoperative outcomes were analyzed and compared between diabetic and non-diabetic patients. Data were presented as median (mean ± SD). Patients were of age 62 (61 ± 13.0) years, BMI of 29 (29 ± 5.9) kg/m2, and ASA class of 3 (3 ± 0.55). The mass size was 5 (5 ± 3.0) cm. Operative duration was 252 (277 ± 106.6) min with estimated blood loss (EBL) was 175 (249 ± 275.9) mL. One operation was converted to 'open' due to bleeding, accounting for one intraoperative complication. Postoperatively, nine patients required ICU admission, with a duration of 1 (4 ± 5.9) day. Seven patients had postoperative complications. Length of stay (LOS) was 4 (4 ± 2.6) days. Fourteen patients were readmitted within 30 days. There were no deaths in-hospital or within 30 days. Of the 94 patients, 22 were diabetic and 72 were nondiabetic. Diabetic patients were older (70 (69 ± 11.3) years versus 58 (58 ± 12.4) years (p = 0.004)). Intraoperatively, operative duration, EBL, and complications were not significantly different. Postoperatively, LOS, ICU admission, ICU duration, complications, in-hospital mortality, readmission in 30 days, and death after 30 days showed no significant difference between diabetics and nondiabetics. In our experience, diabetes has no significant effect on perioperative outcomes after a robotic major hepatectomy.
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Affiliation(s)
- Aryan Modasi
- AdventHealth Tampa, Digestive Health Institute, Tampa, FL, USA
| | - Iswanto Sucandy
- AdventHealth Tampa, Digestive Health Institute, Tampa, FL, USA.
- AdventHealth Tampa, 3000 Medical Park Drive Suite 500, Tampa, FL, 33613, USA.
| | - Sharona Ross
- AdventHealth Tampa, Digestive Health Institute, Tampa, FL, USA
| | - Emily Krill
- AdventHealth Tampa, Digestive Health Institute, Tampa, FL, USA
| | - Miguel Castro
- AdventHealth Tampa, Digestive Health Institute, Tampa, FL, USA
| | - Trenton Lippert
- AdventHealth Tampa, Digestive Health Institute, Tampa, FL, USA
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