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Espinel Y, Rabbani N, Bui TB, Ribeiro M, Buc E, Bartoli A. Keyhole-aware laparoscopic augmented reality. Med Image Anal 2024; 94:103161. [PMID: 38574543 DOI: 10.1016/j.media.2024.103161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 11/29/2023] [Accepted: 03/26/2024] [Indexed: 04/06/2024]
Abstract
Augmented Reality (AR) from preoperative data is a promising approach to improve intraoperative tumour localisation in Laparoscopic Liver Resection (LLR). Existing systems register the preoperative tumour model with the laparoscopic images and render it by direct camera projection, as if the organ were transparent. However, a simple geometric reasoning shows that this may induce serious surgeon misguidance. This is because the tools enter in a different keyhole than the laparoscope. As AR is particularly important for deep tumours, this problem potentially hinders the whole interest of AR guidance. A remedy to this issue is to project the tumour from its internal position to the liver surface towards the tool keyhole, and only then to the camera. This raises the problem of estimating the tool keyhole position in laparoscope coordinates. We propose a keyhole-aware pipeline which resolves the problem by using the observed tool to probe the keyhole position and by showing a keyhole-aware visualisation of the tumour. We assess the benefits of our pipeline quantitatively on a geometric in silico model and on a liver phantom model, as well as qualitatively on three patient data.
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Affiliation(s)
- Yamid Espinel
- Université Clermont Auvergne, 28 place Henri Dunant, 63000 Clermont-Ferrand, France; Centre Hospitalier Universitaire de Clermont-Ferrand, 58 rue Montalembert, 63000 Clermont-Ferrand, France.
| | - Navid Rabbani
- Université Clermont Auvergne, 28 place Henri Dunant, 63000 Clermont-Ferrand, France; Centre Hospitalier Universitaire de Clermont-Ferrand, 58 rue Montalembert, 63000 Clermont-Ferrand, France.
| | - Thien Bao Bui
- SURGAR Surgery, 22 allée Alan Turing, 63000 Clermont-Ferrand, France.
| | - Mathieu Ribeiro
- Centre Hospitalier Universitaire de Clermont-Ferrand, 58 rue Montalembert, 63000 Clermont-Ferrand, France.
| | - Emmanuel Buc
- Centre Hospitalier Universitaire de Clermont-Ferrand, 58 rue Montalembert, 63000 Clermont-Ferrand, France.
| | - Adrien Bartoli
- Université Clermont Auvergne, 28 place Henri Dunant, 63000 Clermont-Ferrand, France; Centre Hospitalier Universitaire de Clermont-Ferrand, 58 rue Montalembert, 63000 Clermont-Ferrand, France.
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Peng Z, Zhu ZR, He CY, Huang H. A meta-analysis: laparoscopic versus open liver resection for large hepatocellular carcinoma. MINIM INVASIV THER 2024:1-11. [PMID: 38634257 DOI: 10.1080/13645706.2024.2334762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 02/18/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND The indication of laparoscopic liver resection (LLR) for treating large hepatocellular carcinoma (HCC) is controversial. In this study, we compared the short-term and long-term outcomes of LLR and open liver resection (OLR) for large HCC. MATERIAL AND METHODS We searched eligible articles about LLR versus OLR for large HCC in PubMed, Cochrane Library, and EMBASE and performed a meta-analysis. RESULTS Eight publications involving 1,338 patients were included. Among them, 495 underwent LLR and 843 underwent OLR. The operation time was longer in the LLR group (MD: 22.23, 95% CI: 4.14-40.33, p = 0.02). but the postoperative hospital stay time was significantly shorter (MD : -4.88, CI: -5.55 to -4.23, p < 0.00001), and the incidence of total postoperative complications and major complications were significantly fewer (OR: 0.49, 95% CI:0.37-0.66, p < 0.00001; OR: 0.54, 95% CI:0.36 - 0.82, p = 0.003, respectively). Patients in the laparoscopic group had no significant difference in intraoperative blood loss, intraoperative transfusion rate, resection margin size, R0 resection rate, three-year overall survival (OS) and three-year disease-free survival (DFS). CONCLUSION LLR for large HCC is safe and feasible. This surgical strategy will not affect the long-term outcomes of patients.
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Affiliation(s)
- Zha Peng
- Guangxi Medical University, Nanning, China
- Department of Hepatobiliary Surgery, Guangxi Medical University Affiliated Wuming Hospital, Nanning, China
| | - Zhuang-Rong Zhu
- Guangxi Medical University, Nanning, China
- Department of Hepatobiliary Surgery, Guangxi Medical University Affiliated Wuming Hospital, Nanning, China
| | - Cheng-Yi He
- Department of Hepatobiliary Surgery, Guangxi Medical University Affiliated Wuming Hospital, Nanning, China
| | - Hai Huang
- Department of Hepatobiliary Surgery, Guangxi Medical University Affiliated Wuming Hospital, Nanning, China
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He ZQ, Mao YL, Lv TR, Liu F, Li FY. A meta-analysis between robotic hepatectomy and conventional open hepatectomy. J Robot Surg 2024; 18:166. [PMID: 38587718 DOI: 10.1007/s11701-024-01882-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 02/22/2024] [Indexed: 04/09/2024]
Abstract
Current meta-analysis was performed to compare robotic hepatectomy (RH) with conventional open hepatectomy (OH) in terms of peri-operative and postoperative outcomes. PubMed, EMBASE, and the Cochrane Library were all searched up for comparative studies between RH and OH. RevMan5.3 software and Stata 13.0 software were used for statistical analysis. Nineteen studies with 1747 patients who received RH and 23,633 patients who received OH were included. Pooled results indicated that patients who received RH were generally younger than those received OH (P < 0.00001). Moreover, RH was associated with longer operative time (P = 0.0002), less intraoperative hemorrhage (P < 0.0001), lower incidence of intraoperative transfusion (P = 0.003), lower incidence of postoperative any morbidity (P < 0.00001), postoperative major morbidity (P = 0.0001), mortalities with 90 days after surgery (P < 0.0001), and shorter length of postoperative hospital stay (P < 0.00001). Comparable total hospital costs were acquired between RH and OH groups (P = 0.46). However, even at the premise of comparable R0 rate (P = 0.86), RH was associated with smaller resected tumor size (P < 0.00001). Major hepatectomy (P = 0.02) and right posterior hepatectomy (P = 0.0003) were less frequently performed in RH group. Finally, we concluded that RH was superior to OH in terms of peri-operative and postoperative outcomes. RH could lead to less intraoperative hemorrhage, less postoperative complications and an enhanced postoperative recovery. However, major hepatectomy and right posterior hepatectomy were still less frequently performed via robotic approach. Future more powerful well-designed studies are required for further exploration.
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Affiliation(s)
- Zhi-Qiang He
- Department of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ya-Ling Mao
- Day Surgery Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Tian-Run Lv
- Department of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Fei Liu
- Department of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Fu-Yu Li
- Department of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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Laroche S, Lim C, Goumard C, Rayar M, Cherqui D, Chiche L, Barbier L, Salamé E, Mabrut JY, Lesurtel M, Truant S, Boleslawski E, Muscari F, Hobeika C, Chirica M, Buc E, Hardwigsen J, Herrero A, Navarro F, Faitot F, Bachellier P, Regimbeau JM, Laurent A, Fuks D, Soubrane O, Azoulay D, Vibert E, Scatton O. Comparing indications, complexity and outcomes of laparoscopic liver resection between centers with and without a liver transplant program: a French nationwide study. HPB (Oxford) 2024; 26:586-593. [PMID: 38341287 DOI: 10.1016/j.hpb.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND There are no data to evaluate the difference in populations and impact of centers with liver transplant programs in performing laparoscopic liver resection (LLR). METHODS This was a multicenter study including patients undergoing LLR for benign and malignant tumors at 27 French centers from 1996 to 2018. The main outcomes were postoperative severe morbidity and mortality. RESULTS A total of 3154 patients were included, and 14 centers were classified as transplant centers (N = 2167 patients, 68.7 %). The transplant centers performed more difficult LLRs and more resections for hepatocellular carcinoma (HCC) in patients who more frequently had cirrhosis. A higher rate of performing the Pringle maneuver, a lower rate of blood loss and a higher rate of open conversion (all p < 0.05) were observed in the transplant centers. There was no association between the presence of a liver transplant program and either postoperative severe morbidity (<10 % in each group; p = 0.228) or mortality (1 % in each group; p = 0.915). CONCLUSIONS Most HCCs, difficult LLRs, and cirrhotic patients are treated in transplant centers. We show that all centers can achieve comparable safety and quality of care in LLR independent of the presence of a liver transplant program.
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Affiliation(s)
- Sophie Laroche
- Sorbonne University, Paris, France; Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
| | - Chetana Lim
- Sorbonne University, Paris, France; Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France; Research Unit, Université de Picardie-Jules Verne, UR UPJV 7518 SSPC, Amiens, France
| | - Claire Goumard
- Sorbonne University, Paris, France; Centre de Recherche de Saint-Antoine (CRSA), INSERM, UMRS-938, Paris, France
| | - Michel Rayar
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Claude Huriez Hospital, Rennes, France
| | - Daniel Cherqui
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP Paul Brousse Hospital, Villejuif, France
| | - Laurence Chiche
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Bordeaux University Hospital-Magellan Centre, Bordeaux, France
| | - Louise Barbier
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Bordeaux University Hospital-Magellan Centre, Bordeaux, France
| | - Ephrem Salamé
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Trousseau Hospital, Tours Regional University Hospital, Tours, France
| | - Jean-Yves Mabrut
- Department of Hepatopancreato-Biliary Surgery and Liver Transplantation, La Croix Rousse Hospital, Lyon, France
| | - Mickael Lesurtel
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP Beaujon Hospital, Clichy, France
| | - Stéphanie Truant
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP Beaujon Hospital, Clichy, France
| | - Emmanuel Boleslawski
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Claude Huriez Hospital, Lille, France
| | - Fabrice Muscari
- Department of Hepato-Pancreatic-Biliary Surgery and Liver Transplantation, Rangueil Hospital, Toulouse, France
| | - Christian Hobeika
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP Beaujon Hospital, Clichy, France
| | - Mircea Chirica
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Grenoble Alpes Hospital, Grenoble, France
| | - Emmanuel Buc
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Estaing Hospital, Clermont-Ferrand, France
| | - Jean Hardwigsen
- Department of Hepatopancreato-Biliary Surgery and Liver Transplantation, La Timone Hospital, Marseille, France
| | - Astrid Herrero
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Saint-Eloi Hospital, Montpellier, France
| | - Francis Navarro
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Saint-Eloi Hospital, Montpellier, France
| | - François Faitot
- Department of Hepatopancreato-Biliary Surgery and Liver Transplantation, Hautepierre Hospital, Strasbourg, France
| | - Philippe Bachellier
- Department of Hepatopancreato-Biliary Surgery and Liver Transplantation, Hautepierre Hospital, Strasbourg, France
| | - Jean-Marc Regimbeau
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France; Research Unit, Université de Picardie-Jules Verne, UR UPJV 7518 SSPC, Amiens, France
| | - Alexis Laurent
- Department of Hepato-Pancreato-Biliary Surgery, APHP Henri Mondor Hospital, Creteil, France
| | - David Fuks
- Department of Hepato-Pancreato-Biliary Surgery, APHP Cochin Hospital, Paris, France
| | - Olivier Soubrane
- Sorbonne University, Paris, France; Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France; Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, Paris France
| | - Daniel Azoulay
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP Paul Brousse Hospital, Villejuif, France
| | - Eric Vibert
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP Paul Brousse Hospital, Villejuif, France
| | - Olivier Scatton
- Sorbonne University, Paris, France; Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France; Centre de Recherche de Saint-Antoine (CRSA), INSERM, UMRS-938, Paris, France.
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Huang DF, Xu JB, Du YM, Wang YB, Zhou DH. Application of the Left Lateral Decubitus Position in Laparoscopic Right Posterior Lobectomy. Surg Laparosc Endosc Percutan Tech 2024; 34:178-184. [PMID: 38417113 DOI: 10.1097/sle.0000000000001264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/01/2023] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To investigate the value of the left lateral decubitus position in laparoscopic right posterior lobe tumor resection. PATIENTS AND METHODS The clinical data of patients who underwent laparoscopic right posterior lobectomy from January 2020 to March 2023 were retrospectively collected and divided into group A (left lateral decubitus position group, n=30) and group B (conventional position group, n=35) according to different body positions. Intraoperative and postoperative data were collected and compared between the 2 groups. RESULTS The operation time (210.43±57.56 vs. 281.97±65.89, t =5.887, P <0.05), hilar occlusion time (23.97±14.25 vs. 35.79±12.62, t =4.791, P <0.05), intraoperative blood loss (162.14±72.61 vs. 239.65±113.56, t =5.713, P <0.05), postoperative feeding time (1.13±0.36 vs. 1.57±0.67, t =3.681, P <0.05), postoperative visual analog scale score (5.16±0.89 vs. 7.42±1.31, t =3.721, P <0.05), postoperative abdominal drainage tube indwelling time (4.58±1.34 vs. 5.42±1.52, t =4.553, P <0.05), incidence rate of complications (43.33% vs. 82.86%, χ 2 =11.075, P <0.05) in group A were lower than those in group B ( P <0.05). Symptoms/side effects (32.42±3.42 vs. 27.44±3.31, t =4.331, P <0.05), and there were significant differences in social function (33.55±2.56 vs. 29.31±3.32, t =4.863, P <0.05). CONCLUSION For right posterior lobe tumors of the liver, the left lateral decubitus position has many advantages in laparoscopic right posterior lobectomy, such as a wide field of view, simple steps, a short operation time, less bleeding, and a high postoperative quality of life. It is an effective treatment for right posterior lobe tumors of the liver and is worthy of being widely popularized.
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Affiliation(s)
- Dong-Fang Huang
- Department of Hepatobiliary Surgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian
- Department of Hepatobiliary Surgery, Medical College of Soochow University, Suzhou
| | - Jian-Bo Xu
- Department of Hepatobiliary Surgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian
| | - Ye-Mu Du
- Department of Hepatobiliary Surgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian
| | - Ye-Bo Wang
- Department of Hepatobiliary Surgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian
| | - Ding-Hua Zhou
- Department of Hepatobiliary Surgery, PLA Rocket Force Characteristic Medical Center, Beijing, China
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Cassese G, Han HS, Yoon YS, Lee JS, Lee B, Lee HW, Cho JY. Evolution of laparoscopic liver resection in the last two decades: lessons from 2000 cases at a referral Korean center. Surg Endosc 2024; 38:1200-1210. [PMID: 38087108 DOI: 10.1007/s00464-023-10580-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 11/04/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND AND AIMS Laparoscopic liver resection (LLR) has evolved to become the standard surgical approach in many referral centers worldwide. The aim of this study was to analyze how LLR evolved at a single high-volume referral center since its introduction, more than two decades ago. METHODS Data from all consecutive LLR between January 2003 and September 2022 at the Seoul National University Bundang Hospital were analyzed. Perioperative outcomes were compared between three time periods, with major technological innovations considered as landmarks: before introduction of laparoscopic-US and CUSA (2003-2006), before (2006-2015) and after (2015-2022) introduction of high-definition scope. RESULTS During the analyzed time periods the number of technically challenging procedures increased from 39.2 to 61.1% (p < 0.001). The most recent period showed shorter median operation time (from 267.5' to 175', p < 0.001), lower median estimated blood loss (EBL) (from 500 to 300 ml, p < 0.001), lower intraoperative transfusions (from 33.8 to 9.3%, p < 0.001), shorter median postoperative hospital stay (from 12 to 6 days, p < 0.001). The time period, a technical major resection and an underlying liver cirrhosis were found to be the associated with longer operation time (p < 0.001) in the multivariable linear regression analysis, while tumor size, technically major surgeries and liver cirrhosis were associated with higher EBL (p < 0.001). CONCLUSION During the last two decades, the indications for patients undergoing LLR have expanded significantly, including more and more challenging procedures and frail patients. Despite such challenges, perioperative outcomes improved, although technically major procedures, cirrhotic patients and huge tumors have still to be considered challenging situations.
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Affiliation(s)
- Gianluca Cassese
- Department of Surgery, Division of HPB Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, and Transplantation Service, Federico II University, Naples, Italy
| | - Ho-Seong Han
- Department of Surgery, Division of HPB Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.
- Department of Surgery, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
| | - Yoo-Seok Yoon
- Department of Surgery, Division of HPB Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jun-Suh Lee
- Department of Surgery, Division of HPB Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Boram Lee
- Department of Surgery, Division of HPB Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hae Won Lee
- Department of Surgery, Division of HPB Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jai Young Cho
- Department of Surgery, Division of HPB Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
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Sheng Y, Zheng J, Tao L, Shen Z, Liang X. Risk factor analysis of conversion in laparoscopic liver resection for intrahepatic cholangiocarcinoma. Surg Endosc 2024; 38:1191-1199. [PMID: 38082010 DOI: 10.1007/s00464-023-10579-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 11/04/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND The risk factors of patients with intrahepatic cholangiocarcinoma (ICC) requiring conversion to open surgery have not been adequately studied. This study aimed to determine the risk factors and postoperative outcomes of conversion in patients with ICC. METHODS From May 2014 to September 2022, Unplanned conversions were compared with successful LLRs. RESULTS 153 patients with ICC initially underwent LLR, of which 41 (26.8%) required conversion to open surgery. Multivariate analysis for those factors that were statistically significant or confirmed by clinical studies, tumor proximity to the major vessels (OR 6.643, P < 0.001), and previous upper abdominal surgery (OR 3.140, P = 0.040) were independent predictors of unplanned conversions. Compared to successful LLRs, unplanned conversions showed longer operative times (300.0 vs. 225.0 min, P < 0.001), more blood loss (500.0 vs. 200.0 mL, P < 0.001), higher transfusion rates (46.3% vs. 11.6%, P < 0.001), longer length of stays (13.0 vs. 8.0 days, P < 0.001), and higher rates of major morbidity (39.0% vs. 11.6%, P < 0.001). However, there was no statistically significant difference in 30-day or 90-day mortality between the conversion group and the laparoscopic group. CONCLUSION Conversion during LLR should be anticipated in ICC patients with prior upper abdominal surgery or tumor proximity to major vessels as features.
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Affiliation(s)
- Yubin Sheng
- Department of General Surgery, The First People's Hospital of Jiashan County, No. 1218, South Sports Road, Jiashan, 314100, China
- Department of General Surgery, Zhejiang University, School of Medicine, Sir Run Run Shaw Hospital, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Junhao Zheng
- Department of General Surgery, Zhejiang University, School of Medicine, Sir Run Run Shaw Hospital, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Liye Tao
- Department of General Surgery, Zhejiang University, School of Medicine, Sir Run Run Shaw Hospital, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Zefeng Shen
- Department of General Surgery, Zhejiang University, School of Medicine, Sir Run Run Shaw Hospital, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Xiao Liang
- Department of General Surgery, Zhejiang University, School of Medicine, Sir Run Run Shaw Hospital, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China.
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Wise PA, Preukschas AA, Özmen E, Bellemann N, Norajitra T, Sommer CM, Stock C, Mehrabi A, Müller-Stich BP, Kenngott HG, Nickel F. Intraoperative liver deformation and organ motion caused by ventilation, laparotomy, and pneumoperitoneum in a porcine model for image-guided liver surgery. Surg Endosc 2024; 38:1379-1389. [PMID: 38148403 PMCID: PMC10881715 DOI: 10.1007/s00464-023-10612-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/26/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Image-guidance promises to make complex situations in liver interventions safer. Clinical success is limited by intraoperative organ motion due to ventilation and surgical manipulation. The aim was to assess influence of different ventilatory and operative states on liver motion in an experimental model. METHODS Liver motion due to ventilation (expiration, middle, and full inspiration) and operative state (native, laparotomy, and pneumoperitoneum) was assessed in a live porcine model (n = 10). Computed tomography (CT)-scans were taken for each pig for each possible combination of factors. Liver motion was measured by the vectors between predefined landmarks along the hepatic vein tree between CT scans after image segmentation. RESULTS Liver position changed significantly with ventilation. Peripheral regions of the liver showed significantly higher motion (maximal Euclidean motion 17.9 ± 2.7 mm) than central regions (maximal Euclidean motion 12.6 ± 2.1 mm, p < 0.001) across all operative states. The total average motion measured 11.6 ± 0.7 mm (p < 0.001). Between the operative states, the position of the liver changed the most from native state to pneumoperitoneum (14.6 ± 0.9 mm, p < 0.001). From native state to laparotomy comparatively, the displacement averaged 9.8 ± 1.2 mm (p < 0.001). With pneumoperitoneum, the breath-dependent liver motion was significantly reduced when compared to other modalities. Liver motion due to ventilation was 7.7 ± 0.6 mm during pneumoperitoneum, 13.9 ± 1.1 mm with laparotomy, and 13.5 ± 1.4 mm in the native state (p < 0.001 in all cases). CONCLUSIONS Ventilation and application of pneumoperitoneum caused significant changes in liver position. Liver motion was reduced but clearly measurable during pneumoperitoneum. Intraoperative guidance/navigation systems should therefore account for ventilation and intraoperative changes of liver position and peripheral deformation.
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Affiliation(s)
- Philipp A Wise
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Anas A Preukschas
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Emre Özmen
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Nadine Bellemann
- Department of Diagnostic and Interventional Radiology, Heidelberg University, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Tobias Norajitra
- Division of Medical and Biological Informatics, German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Christof M Sommer
- Department of Diagnostic and Interventional Radiology, Heidelberg University, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Christian Stock
- Institute for Medical Biometry and Informatics, Heidelberg University, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Beat P Müller-Stich
- Division of Abdominal Surgery, Clarunis-Academic Centre of Gastrointestinal Diseases, St. Clara and University Hospital of Basel, Petersgraben 4, 4051, Basel, Switzerland
| | - Hannes G Kenngott
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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Navinés-López J, Pardo Aranda F, Cremades Pérez M, Espin Álvarez F, Zárate Pinedo A, Cugat Andorrà E. Microfracture-coagulation for the real robotic liver parenchymal transection. J Robot Surg 2024; 18:101. [PMID: 38421523 PMCID: PMC10904403 DOI: 10.1007/s11701-024-01842-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/21/2024] [Indexed: 03/02/2024]
Abstract
The use of the robotic approach in liver surgery is exponentially increasing. Although technically the robot introduces several innovative features, the instruments linked with the traditional laparoscopic approach for the liver parenchymal transection are not available, which may result in multiple technical variants that may bias the comparative analysis between the different series worldwide. A real robotic approach, minimally efficient for the liver parenchymal transection, with no requirement of external tool, available for the already existing platforms, and applicable to any type of liver resection, counting on the selective use of the plugged bipolar forceps and the monopolar scissors, or "microfracture-coagulation" (MFC) transection method, is described in detail. The relevant aspects of the technique, its indications and methodological basis are discussed.
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Affiliation(s)
- Jordi Navinés-López
- Universitat Autònoma de Barcelona, Hospital Universitari Germans Trias i Pujol de Badalona, HPB unit, Badalona, Barcelona, Spain.
| | - Fernando Pardo Aranda
- Universitat Autònoma de Barcelona, Hospital Universitari Germans Trias i Pujol de Badalona, HPB unit, Badalona, Barcelona, Spain
| | - Manel Cremades Pérez
- Universitat Autònoma de Barcelona, Hospital Universitari Germans Trias i Pujol de Badalona, HPB unit, Badalona, Barcelona, Spain
| | - Francisco Espin Álvarez
- Universitat Autònoma de Barcelona, Hospital Universitari Germans Trias i Pujol de Badalona, HPB unit, Badalona, Barcelona, Spain
| | - Alba Zárate Pinedo
- Universitat Autònoma de Barcelona, Hospital Universitari Germans Trias i Pujol de Badalona, HPB unit, Badalona, Barcelona, Spain
| | - Esteban Cugat Andorrà
- Universitat Autònoma de Barcelona, Hospital Universitari Germans Trias i Pujol de Badalona, HPB unit, Badalona, Barcelona, Spain
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10
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Wang XR, Li XJ, Wan DD, Zhang Q, Liu TX, Shen ZW, Tong HX, Li Y, Li JW. Laparoscopic left hemihepatectomy guided by indocyanine green fluorescence: A cranial-dorsal approach. World J Gastrointest Surg 2024; 16:409-418. [PMID: 38463374 PMCID: PMC10921191 DOI: 10.4240/wjgs.v16.i2.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/14/2023] [Accepted: 01/24/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Advancements in laparoscopic technology and a deeper understanding of intrahepatic anatomy have led to the establishment of more precise laparoscopic hepatectomy (LH) techniques. The indocyanine green (ICG) fluorescence navigation technique has emerged as the most effective method for identifying hepatic regions, potentially overcoming the limitations of LH. While laparoscopic left hemihepatectomy (LLH) is a standardized procedure, there is a need for innovative strategies to enhance its outcomes. AIM To investigate a standardized cranial-dorsal strategy for LLH, focusing on important anatomical markers, surgical skills, and ICG staining methods. METHODS Thirty-seven patients who underwent ICG fluorescence-guided LLH at Qujing Second People's Hospital between January 2019 and February 2022 were retrospectively analyzed. The cranial-dorsal approach was performed which involves dissecting the left hepatic vein cephalad, isolating the Arantius ligament , exposing the middle hepatic vein, and dissecting the parenchyma from the dorsal to the foot in order to complete the anatomical LLH. The surgical methods, as well as intra- and post-surgical data, were recorded and analyzed. Our hospital's Medical Ethics Committee approved this study (Ethical review: 2022-019-01). RESULTS Intraoperative blood loss during LLH was 335.68 ± 99.869 mL and the rates of transfusion and conversion to laparotomy were 13.5% and 0%, respectively. The overall incidence of complications throughout the follow-up (median of 18 months; range 1-36 months) was 21.6%. No mortality or severe complications (level IV) were reported. CONCLUSION LLH has the potential to become a novel, standardized approach that can effectively, safely, and simply expose the middle hepatic vein and meet the requirements of precision surgery.
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Affiliation(s)
- Xing-Ru Wang
- Institute of Hepatobiliary Surgery, First Affiliated Hospital, Army Medical University, Chongqing 400038, China
| | - Xiao-Ju Li
- Department of Hepatobiliary Surgery, Qujing Central Hospital of Yunnan Regional Medical Center, Qujing 655000, Yunnan Province, China
| | - Dan-Dan Wan
- School of Clinical Medicine, Qujing Medical College, Qujing 655000, Yunnan Province, China
| | - Qian Zhang
- Department of Hepatobiliary Surgery, Qujing Central Hospital of Yunnan Regional Medical Center, Qujing 655000, Yunnan Province, China
| | - Tian-Xi Liu
- Department of Hepatobiliary Surgery, Qujing Central Hospital of Yunnan Regional Medical Center, Qujing 655000, Yunnan Province, China
| | - Zong-Wen Shen
- Department of Hepatobiliary Surgery, Qujing Central Hospital of Yunnan Regional Medical Center, Qujing 655000, Yunnan Province, China
| | - Hong-Xing Tong
- Department of Hepatobiliary Surgery, Qujing Central Hospital of Yunnan Regional Medical Center, Qujing 655000, Yunnan Province, China
| | - Yan Li
- Department of Hepatobiliary Surgery, Qujing Central Hospital of Yunnan Regional Medical Center, Qujing 655000, Yunnan Province, China
| | - Jian-Wei Li
- Institute of Hepatobiliary Surgery, First Affiliated Hospital, Army Medical University, Chongqing 400038, China
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11
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Pan SB, Wu CL, Zhou DC, Xiong QR, Geng XP, Hou H. Total laparoscopic partial hepatectomy versus open partial hepatectomy for primary left-sided hepatolithiasis: study protocol for a randomized controlled trial. Trials 2024; 25:137. [PMID: 38383461 PMCID: PMC10882851 DOI: 10.1186/s13063-023-07476-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 06/26/2023] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND The advantages of laparoscopic left-sided hepatectomy (LLH) for treating hepatolithiasis in terms of the time to postoperative length of hospital stay (LOS), morbidity, long-term abdominal wall hernias, hospital costs, residual stone rate, and recurrence of calculus have not been confirmed by a randomized controlled trial. The aim of this trial is to compare the safety and effectiveness of LLH with open left-sided hepatectomy (OLH) for the treatment of hepatolithiasis. METHODS Patients with hepatolithiasis eligible for left-sided hepatectomy will be recruited. The experimental design will produce two randomized arms (laparoscopic and open hepatectomy) at a 1:1 ratio and a prospective registry. All patients will undergo surgery in the setting of an enhanced recovery after surgery (ERAS) programme. The prospective registry will be based on patients who cannot be randomized because of the explicit treatment preference of the patient or surgeon or because of ineligibility (not meeting the inclusion and exclusion criteria) for randomization in this trial. The primary outcome is the LOS. The secondary outcomes are percentage readmission, morbidity, mortality, hospital costs, long-term incidence of incisional hernias, residual stone rate, and recurrence of calculus. It will be assumed that, in patients undergoing LLH, the length of hospital stay will be reduced by 1 day. A sample size of 86 patients in each randomization arm has been calculated as sufficient to detect a 1-day reduction in LOS [90% power and α = 0.05 (two-tailed)]. The trial is a randomized controlled trial that will provide evidence for the merits of laparoscopic surgery in patients undergoing liver resection within an ERAS programme. CONCLUSIONS Although the outcomes of LLH have been proven to be comparable to those of OLH in retrospective studies, the use of LLH remains restricted, partly due to the lack of short- and long-term informative RCTs pertaining to patients with hepatolithiasis in ERAS programmes. To evaluate the surgical and long-term outcomes of LLH, we will perform a prospective RCT to compare LLH with OLH for hepatolithiasis within an ERAS programme. TRIAL REGISTRATION ClinicalTrials.gov NCT03958825. Registered on 21 May 2019.
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Affiliation(s)
- Shu-Bo Pan
- Department of General Surgery, The Second Affiliated Hospital of Anhui Medical University, Furong Road 678#, Shushan District, Hefei, 230601, Anhui, China
| | - Chun-Li Wu
- Department of General Surgery, The Second Affiliated Hospital of Anhui Medical University, Furong Road 678#, Shushan District, Hefei, 230601, Anhui, China
| | - Da-Chen Zhou
- Department of General Surgery, The Second Affiliated Hospital of Anhui Medical University, Furong Road 678#, Shushan District, Hefei, 230601, Anhui, China
| | - Qi-Ru Xiong
- Department of General Surgery, The Second Affiliated Hospital of Anhui Medical University, Furong Road 678#, Shushan District, Hefei, 230601, Anhui, China
| | - Xiao-Ping Geng
- Department of General Surgery, The Second Affiliated Hospital of Anhui Medical University, Furong Road 678#, Shushan District, Hefei, 230601, Anhui, China
| | - Hui Hou
- Department of General Surgery, The Second Affiliated Hospital of Anhui Medical University, Furong Road 678#, Shushan District, Hefei, 230601, Anhui, China.
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12
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Hong SK, Kim JY, Lee J, Kim J, Choi HH, Lee S, Hong SY, Lee JM, Choi Y, Yi NJ, Lee KW, Suh KS. Pure laparoscopic donor hepatectomy: Experience of 556 cases at Seoul National University Hospital. Am J Transplant 2024; 24:222-238. [PMID: 37321453 DOI: 10.1016/j.ajt.2023.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/31/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023]
Abstract
Pure laparoscopic donor hepatectomy (PLDH) has become a routine procedure at Seoul National University Hospital, and the pure laparoscopic method is now being applied to liver recipients as well. This study aimed to review the procedure and outcomes of PLDH to identify any areas that required improvement. Data from 556 donors who underwent PLDH between November 2015 and December 2021 and their recipients were retrospectively reviewed. Among these, 541 patients underwent pure laparoscopic donor right hepatectomy (PLDRH). The mean hospital stay of the donor was 7.2 days, and the rate of grade I, II, IIIa, and IIIb complications was 2.2%, 2.7%, 1.3%, and 0.9%, respectively, without any irreversible disabilities or mortalities. The most common early and late major complications in the recipient were intraabdominal bleeding (n = 47, 8.5%) and biliary problems (n = 198, 35.6%), respectively. Analysis of the PLDRH procedure showed that operative time, liver removal time, warm ischemic time, Δhemoglobin%, Δtotal bilirubin%, and postoperative hospital stay decreased significantly as the number of cases accumulated. In conclusion, the operative outcomes of PLDRH improved as the number of cases increased. However, continuous caution is needed because major complications still occur in donors and recipients even after hundreds of cases.
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Affiliation(s)
- Suk Kyun Hong
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.
| | - Jae-Yoon Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Jaewon Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Jiyoung Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyun Hwa Choi
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Sola Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Su Young Hong
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Jeong-Moo Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - YoungRok Choi
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.
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13
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Zhang XP, Jiang N, Zhu L, Lin ZY, Guo WX, Chen X, Ma YT, Zhang F, Tang YF, Chen ZL, Yan ML, Zhao ZM, Li CG, Lau WY, Cheng SQ, Hu MG, Liu R. Short-term and long-term outcomes after robotic versus open hepatectomy in patients with large hepatocellular carcinoma: a multicenter study. Int J Surg 2024; 110:660-667. [PMID: 37983785 PMCID: PMC10871596 DOI: 10.1097/js9.0000000000000873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/22/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Robotic hepatectomy (RH) is currently widely accepted and it is associated with some benefits when compared to open hepatectomy (OH). However, whether such benefits can still be achieved for patients with large hepatocellular carcinoma (HCC) remain unclear. This study aimed to evaluate the short-term and long-term outcomes of patients undergoing RH or OH. METHODS Perioperative and survival data from patients with large HCC who underwent RH or OH between January 2010 and December 2020 were collected from eight centres. Propensity score matching (PSM) was performed to minimise potential biases. RESULTS Using predefined inclusion criteria, 797 patients who underwent OH and 309 patients who underwent RH were enroled in this study. After PSM, 280 patients in the robotic group had shorter operative time (median 181 vs. 201 min, P <0.001), lower estimated blood loss (median 200 vs. 400 ml, P <0.001), and shorter postoperative length of stay (median 6 vs. 9 days, P <0.001) than 465 patients in the open group. There were no significant differences between the two groups in overall survival and recurrence-free survival. Cox analysis showed AFP greater than 400 ng/ml, tumour size greater than 10 cm, and microvascular invasion were independent risk factors for overall survival and recurrence-free survival. After PSM, subgroup analysis showed that patients with a huge HCC (diameter >10 cm) who underwent RH had significantly lower estimated blood loss (median 200.0 vs. 500.0 min, P <0.001), and shorter length of stay (median 7 vs. 10 days, P <0.001) than those who underwent OH. CONCLUSION Safety and feasibility of RH and OH for patients with large HCC were comparable. RH resulted in similar long-term survival outcomes as OH.
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Affiliation(s)
- Xiu-Ping Zhang
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital; Institute of Hepatobiliary Surgery of Chinese PLA; Key Laboratory of Digital Hepatobiliary Surgery, PLA, Beijing
| | - Nan Jiang
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital; Institute of Hepatobiliary Surgery of Chinese PLA; Key Laboratory of Digital Hepatobiliary Surgery, PLA, Beijing
| | - Lin Zhu
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital; Institute of Hepatobiliary Surgery of Chinese PLA; Key Laboratory of Digital Hepatobiliary Surgery, PLA, Beijing
- The First Clinical Medical School, Lanzhou University
| | - Zhao-Yi Lin
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital; Institute of Hepatobiliary Surgery of Chinese PLA; Key Laboratory of Digital Hepatobiliary Surgery, PLA, Beijing
| | - Wei-Xing Guo
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai
| | - Xiong Chen
- Department of Hepatobiliary Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang
| | - Yun-Tao Ma
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, Gansu
| | - Fan Zhang
- Department of Hepatobiliary Surgery, Affiliated Hospital of Binzhou Medical College, Shandong, China Department of Hepato-Biliary-Pancreatic Surgery
| | - Yu-Fu Tang
- Department of Hepatobiliary Surgery, Northern Theatre General Hospital, Liaoning
| | - Zi-Li Chen
- Department of Hepatobiliary Surgery, Affiliated Hospital of Guizhou Medical University, Guizhou
| | - Mao-Lin Yan
- Department of Hepato-Biliary-Pancreatic Surgery, Fujian Provincial Hospital, Fujian
| | - Zhi-Ming Zhao
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital; Institute of Hepatobiliary Surgery of Chinese PLA; Key Laboratory of Digital Hepatobiliary Surgery, PLA, Beijing
| | - Cheng-Gang Li
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital; Institute of Hepatobiliary Surgery of Chinese PLA; Key Laboratory of Digital Hepatobiliary Surgery, PLA, Beijing
| | - Wan Yee Lau
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital; Institute of Hepatobiliary Surgery of Chinese PLA; Key Laboratory of Digital Hepatobiliary Surgery, PLA, Beijing
- Faculty of Medicine, the Chinese University of Hong Kong, Shatin, Hong Kong, SAR, People's Republic of China
| | - Shu-Qun Cheng
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai
| | - Ming-Gen Hu
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital; Institute of Hepatobiliary Surgery of Chinese PLA; Key Laboratory of Digital Hepatobiliary Surgery, PLA, Beijing
| | - Rong Liu
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital; Institute of Hepatobiliary Surgery of Chinese PLA; Key Laboratory of Digital Hepatobiliary Surgery, PLA, Beijing
- The First Clinical Medical School, Lanzhou University
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14
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Wakabayashi T, Fujiyama Y, Mishima K, Igarashi K, Nie Y, Berardi G, Alomari M, Colella M, Wakabayashi G. Laparoscopically Limited Anatomic Liver Resections: A Single-Center Analysis for Oncologic Outcomes of the Conceptual Procedure. Ann Surg Oncol 2024; 31:1243-1251. [PMID: 37947973 DOI: 10.1245/s10434-023-14462-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/02/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Limited anatomic resections (LARs), such as segmentectomies, performed using a fully laparoscopic approach, have gained popularity for liver malignancies. However, the oncologic efficacy of laparoscopic LARs (Lap-LARs) needs further investigation. This cohort study evaluated the oncologic outcomes of Lap-LAR for hepatocellular carcinoma (HCC) and colorectal liver metastasis (CRLM). METHODS At a Japanese referral center, 112 patients underwent Lap-LAR using the Glissonean approach and indocyanine green (ICG) fluorescence navigation. Recurrence-free survival (RFS), overall survival (OS), time to interventional failure (TIF), and time to surgical failure (TSF) were assessed. RESULTS Among the 112 patients (median age, 74 years [range, 66-80 years]; 80 men [71.4 %]), Lap-LAR showed promising results. The median operative time was 348 min (range, 280-460 min), and the median blood loss was 190 mL (range, 95.5-452.0 mL). The median error between the estimated and actual liver volumes was 2 % (1.2-4.8 %). Complications greater than Clavien-Dindo 3a were observed in 11.6 % of the patients. The 5-year RFS, OS, and TIF rates for HCC were 45.1 % ± 7.9 %, 73.1 % ± 6.7 %, and 74.2 % ± 6 .6 %, respectively. The 5-year RFS, OS, and TSF rates for CRLM were 36.8 % ± 8.7 %, 60.1 % ± 13.3 %, and 63.6 % ± 10.4 %, respectively. CONCLUSIONS Lap-LAR showed favorable oncologic outcomes for HCC and CRLM. Its precise technique makes it a promising therapeutic option for liver malignancies. Further comparisons with conventional approaches are warranted.
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Affiliation(s)
- Taiga Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Ageo, Saitama, Japan.
| | - Yoshiki Fujiyama
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Ageo, Saitama, Japan
| | - Kohei Mishima
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Ageo, Saitama, Japan
| | - Kazuharu Igarashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Ageo, Saitama, Japan
| | - Yusuke Nie
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Ageo, Saitama, Japan
| | - Giammauro Berardi
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital of Rome, Rome, Italy
| | - Malek Alomari
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Ageo, Saitama, Japan
| | - Marco Colella
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Ageo, Saitama, Japan
| | - Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Ageo, Saitama, Japan
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15
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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16
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Ng KKC, Cheng KC, Kung JWC, Ho KM, Lok HT, Fung AKY, Chong CCN, Cheung SYS, Lee KF, Wong J, Lai PBS. Comparison of clinical outcome between laparoscopic and open hepatectomy of high difficulty score for hepatocellular carcinoma: a propensity score analysis. Surg Endosc 2024; 38:857-871. [PMID: 38082015 DOI: 10.1007/s00464-023-10634-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/29/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Laparoscopic liver resection (LLR) of high difficulty score is technically challenging. There is a lack of clinical evidence to support its applicability in terms of the long-term survival benefits. This study aims to compare clinical outcomes between LLR and the open liver resection of high difficulty score for hepatocellular carcinoma (HCC). MATERIALS AND METHODS From 2010 to 2020, using Iwate criteria, 424 patients underwent liver resection of high difficulty score by the laparoscopic (n = 65) or open (n = 359) approach. Propensity score (PS) matching was performed between the two groups. Short-term and long-term outcomes were compared between PS-matched groups. Univariate and multivariate analyses were performed to identify prognostic factors affecting survival. RESULTS The laparoscopic group had significantly fewer severe complications (3% vs. 10.8%), and shorter median hospital stays (6 days vs. 8 days) than the open group. Meanwhile, the long-term oncological outcomes were comparable between the two groups, in terms of the tumor recurrence rate (40% vs. 46.1%), the 5-year overall survival rate (75.4% vs. 76.2%), and the 5-year recurrence-free survival rate (50.3% vs. 53.5%). The high preoperative serum alpha-fetoprotein level, multiple tumors, and severe postoperative complications were the independent poor prognostic factors associated with worse overall survival. The surgical approach (Laparoscopic vs. Open) did not influence the survival. CONCLUSION LLR of high difficulty score for selected patients with HCC has better short-term outcomes than the open approach. More importantly, it can achieve similar long-term survival outcomes as the open approach.
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Affiliation(s)
- Kelvin K C Ng
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong.
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, 30 - 32 Ngan Shing Street, New Territories, Hong Kong.
| | - Kai-Chi Cheng
- Department of Surgery, Kwong Wah Hospital, Hong Kong, Hong Kong
| | - Janet W C Kung
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
| | - Kit-Man Ho
- Department of Surgery, Kwong Wah Hospital, Hong Kong, Hong Kong
| | - Hon-Ting Lok
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
| | - Andrew K Y Fung
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
| | - Charing C N Chong
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
| | - Sunny Y S Cheung
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
| | - Kit-Fai Lee
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
| | - John Wong
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
| | - Paul B S Lai
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
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17
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Pan W, Li J, Liu L, Huang Y, Huang M, Liu H. Comparing triple scope-combined bile duct exploration lithotripsy with laparoscopic hepatectomy for hepatolithiasis (with video). Asian J Surg 2024; 47:946-952. [PMID: 38195279 DOI: 10.1016/j.asjsur.2023.12.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/23/2023] [Accepted: 12/08/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND To compare the efficacy of Three-scope combined (laparoscopic, rigid choledochoscopy and electronic choledochoscopy, TS) with laparoscopic hepatectomy (LH) for patients with hepatolithiasis (HL). METHODS Between January 2019 and January 2020, 118 consecutive patients with HL treated with TS (TS group, n = 57) or LH (LH group, n = 61) were analyzed in this study. Perioperative and long-term outcomes, including operative time, intraoperative blood loss, blood transfusion, postoperative bowel function recovery time, postoperative hospital stay, complication rate, stone removal rate, and stone recurrence rate, were compared and analyzed between the two groups. RESULTS Compared with the LH group, the TS group had significantly lower intraoperative blood loss and transfusions, significantly shorter operative time and hospital stay, and fewer complications (P < 0.05 for all). There was no significant difference in the final stone removal rate, stone recurrence rate and postoperative bowel function recovery time (P > 0.05 for all). CONCLUSION TS is a safe and effective treatment for HL and is superior to LH in terms of overall treatment outcome and complications.
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Affiliation(s)
- Wu Pan
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Jiangxi Province, 330000, China.
| | - JunJie Li
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Jiangxi Province, 330000, China.
| | - LingPeng Liu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Jiangxi Province, 330000, China.
| | - Yong Huang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Jiangxi Province, 330000, China.
| | - MingWen Huang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Jiangxi Province, 330000, China.
| | - HongLiang Liu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Jiangxi Province, 330000, China.
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18
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Nigam A, Hawksworth JS, Winslow ER. Minimally Invasive Robotic Techniques for Hepatocellular Carcinoma Resection: How I Do It. Surg Oncol Clin N Am 2024; 33:111-132. [PMID: 37945137 DOI: 10.1016/j.soc.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
The adoption of minimally invasive techniques for hepatocellular resection has progressively increased in North America. Cumulative evidence has demonstrated improved surgical outcomes in patients who undergo minimally invasive hepatectomy. In this review, the authors' approach and methodology to minimally invasive robotic liver resection for hepatocellular carcinoma is discussed.
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Affiliation(s)
- Aradhya Nigam
- Department of Surgery, Medstar Georgetown University Hospital, 3800 Reservoir Road, NW, 4PHC, Washington, DC 20007, USA
| | - Jason S Hawksworth
- Division of Abdominal Organ Transplantation, Columbia University Irving Medical Center, 622 West 168th Street, PH14-105, New York, NY 20032, USA.
| | - Emily R Winslow
- Department of Transplant Surgery, Medstar Georgetown University Hospital, 3800 Reservoir Road, NW, 2PHC, Washington, DC 20007, USA
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19
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Hołówko W, Serednicki W, Bartkowiak M, Wysocki M, Domurat M, Mielko J, Pierściński S, Hogendorf P, Masior Ł, Kalinowski P, Wierdak M, Frączek M, Tarasik A, Wróblewski T, Budzyński A, Pędziwiatr M, Grąt M. Early adoption of laparoscopic liver surgery in Poland: a national retrospective cohort study. Int J Surg 2024; 110:361-371. [PMID: 37816169 PMCID: PMC10793755 DOI: 10.1097/js9.0000000000000840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/29/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND The need for safe and efficient dissemination of minimally invasive approach in liver surgery is among the current challenges for hepatobiliary surgeons. After the stage of innovators and pioneers, the following countries should adopt a laparoscopic approach. The aim of this study was to assess the national experience and trend in implementing laparoscopic liver resection (LLR) in Poland. MATERIALS AND METHODS A national registry of LLR performed in Poland was established in June 2020. All LLR cases performed before were included retrospectively, followed by prospectively collected new cases. Baseline characteristics, preoperative and intraoperative data, short-term results and long-term follow-up were recorded. RESULTS Since 2010 up to the end of 2022 there were 718 LLRs performed in Poland. The national rate of laparoscopic approach has gradually increased since 2017 ( P <0.001), reaching the rate of 11.7% in 2022. There were 443 (61.7%), 107 (14.9%), and 168 (23.4%) LLRs performed in accordance to increasing grades of difficulty. The move towards more demanding cases had an increasing trend over the years ( P <0.001). Total intraoperative adverse event and postoperative severe complications rates were estimated for 13.5% ( n =97) and 6.7% ( n =48), respectively. 30-day reoperation, readmission and postoperative mortality rates were 3.6% ( n =26), 2.8% ( n =20), and 0.8% ( n =6), respectively. While the R0 resection margin was assessed in 643 (89.6%) cases, the total textbook outcomes (TO) were achieved in 525 (74.5%) cases. Overcoming the learning curve of 60 LLRs, resulted in an increasing TO rate from 72.3 to 80.6% ( P =0.024). CONCLUSIONS It is the first national analysis of a laparoscopic approach in liver surgery in Poland. An increasing trend of minimizing invasiveness in liver resection has been observed. Responsible selection of cases in accordance with difficulty may provide results within global benchmark values and textbook outcomes already during the learning curve.
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Affiliation(s)
| | - Wojciech Serednicki
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow
| | | | - Michał Wysocki
- Department of General Surgery and Surgical Oncology, Ludwik Rydygier Memorial Hospital
| | - Marian Domurat
- Department of Oncological Surgery, Regional Oncological Center, Białystok, Poland
| | - Jerzy Mielko
- Department of Surgical Oncology, Medical University of Lublin, Lublin
| | - Stanisław Pierściński
- Department of General and Endocrine Surgery, Nicolaus Copernicus University Collegium Medicum, Bydgoszcz
| | - Piotr Hogendorf
- Department of General and Transplant Surgery, Medical University of Łódź, Barlicki Teaching Hospital, Łódź
| | - Łukasz Masior
- Department of General Transplant and Liver Surgery
- Department of General, Vascular and Oncological Surgery, Medical University of Warsaw, Warsaw
| | | | - Mateusz Wierdak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow
| | - Mariusz Frączek
- Department of General, Vascular and Oncological Surgery, Medical University of Warsaw, Warsaw
| | - Aleksander Tarasik
- Department of Oncological Surgery, Regional Oncological Center, Białystok, Poland
| | | | - Andrzej Budzyński
- Department of General Surgery and Surgical Oncology, Ludwik Rydygier Memorial Hospital
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow
| | - Michał Grąt
- Department of General Transplant and Liver Surgery
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20
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Hays SB, Corvino G, Lorié BD, McMichael WV, Mehdi SA, Rieser C, Rojas AE, Hogg ME. Prince and princesses: The current status of robotic surgery in surgical oncology. J Surg Oncol 2024; 129:164-182. [PMID: 38031870 DOI: 10.1002/jso.27536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/11/2023] [Indexed: 12/01/2023]
Abstract
Robotic surgery has experienced a dramatic increase in utilization across general surgery over the last two decades, including in surgical oncology. Although urologists and gynecologists were the first to show that this technology could be utilized in cancer surgery, the robot is now a powerful tool in the treatment of gastrointestinal, hepato-pancreatico-biliary, colorectal, endocrine, and soft tissue malignancies. While long-term outcomes are still pending, short-term outcomes have showed promise for this technologic advancement of cancer surgery.
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Affiliation(s)
- Sarah B Hays
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Gaetano Corvino
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Benjamin D Lorié
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - William V McMichael
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Syed A Mehdi
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Caroline Rieser
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Aram E Rojas
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Melissa E Hogg
- Department of Surgery, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois, USA
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21
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Delvecchio A, Pavone G, Conticchio M, Piacente C, Varvara M, Ferraro V, Stasi M, Casella A, Filippo R, Tedeschi M, Pullano C, Inchingolo R, Delmonte V, Memeo R. Awake robotic liver surgery: A case report. World J Gastrointest Surg 2023; 15:2954-2961. [PMID: 38222022 PMCID: PMC10784833 DOI: 10.4240/wjgs.v15.i12.2954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/30/2023] [Accepted: 12/06/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND In recent years, minimally invasive liver resection has become a standard of care for liver tumors. Considering the need to treat increasingly fragile patients, general anesthesia is sometimes avoided due to respiratory complications. Therefore, surgical treatment with curative intent is abandoned in favor of a less invasive and less radical approach. Epidural anesthesia has been shown to reduce respiratory complications, especially in elderly patients with pre-existing lung disease. CASE SUMMARY A 77-year-old man with hepatitis-C-virus-related chronic liver disease underwent robotic liver resection for hepatocellular carcinoma. The patient was suffering from hypertension, diabetes and chronic obstructive pulmonary disease. The National Surgical Quality Improvement Program score for developing pneumonia was 9.2%. We planned a combined spinal-epidural anesthesia with conscious sedation to avoid general anesthesia. No modification of the standard surgical technique was necessary. Hemodynamics were stable and bleeding was minimal. The postoperative course was uneventful. CONCLUSION Robotic surgery in locoregional anesthesia with conscious sedation could be considered a safe and suitable approach in specialized centers and in selected patients.
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Affiliation(s)
- Antonella Delvecchio
- Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Gaetano Pavone
- Unit of Anesthesia and Perioperative Medicine, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Maria Conticchio
- Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Claudia Piacente
- Unit of Anesthesia and Perioperative Medicine, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Miriam Varvara
- Unit of Anesthesia and Perioperative Medicine, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Valentina Ferraro
- Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Matteo Stasi
- Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Annachiara Casella
- Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Rosalinda Filippo
- Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Michele Tedeschi
- Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | | | - Riccardo Inchingolo
- Unit of Interventional Radiology, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Vito Delmonte
- Unit of Anesthesia and Perioperative Medicine, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Riccardo Memeo
- Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” Regional General Hospital, Bari 70021, Italy
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22
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Sermonesi G, Tian BWCA, Vallicelli C, Abu-Zidan FM, Damaskos D, Kelly MD, Leppäniemi A, Galante JM, Tan E, Kirkpatrick AW, Khokha V, Romeo OM, Chirica M, Pikoulis M, Litvin A, Shelat VG, Sakakushev B, Wani I, Sall I, Fugazzola P, Cicuttin E, Toro A, Amico F, Mas FD, De Simone B, Sugrue M, Bonavina L, Campanelli G, Carcoforo P, Cobianchi L, Coccolini F, Chiarugi M, Di Carlo I, Di Saverio S, Podda M, Pisano M, Sartelli M, Testini M, Fette A, Rizoli S, Picetti E, Weber D, Latifi R, Kluger Y, Balogh ZJ, Biffl W, Jeekel H, Civil I, Hecker A, Ansaloni L, Bravi F, Agnoletti V, Beka SG, Moore EE, Catena F. Cesena guidelines: WSES consensus statement on laparoscopic-first approach to general surgery emergencies and abdominal trauma. World J Emerg Surg 2023; 18:57. [PMID: 38066631 PMCID: PMC10704840 DOI: 10.1186/s13017-023-00520-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/01/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Laparoscopy is widely adopted across nearly all surgical subspecialties in the elective setting. Initially finding indication in minor abdominal emergencies, it has gradually become the standard approach in the majority of elective general surgery procedures. Despite many technological advances and increasing acceptance, the laparoscopic approach remains underutilized in emergency general surgery and in abdominal trauma. Emergency laparotomy continues to carry a high morbidity and mortality. In recent years, there has been a growing interest from emergency and trauma surgeons in adopting minimally invasive surgery approaches in the acute surgical setting. The present position paper, supported by the World Society of Emergency Surgery (WSES), aims to provide a review of the literature to reach a consensus on the indications and benefits of a laparoscopic-first approach in patients requiring emergency abdominal surgery for general surgery emergencies or abdominal trauma. METHODS This position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of 54 experts then critically revised the manuscript and discussed it in detail, to develop a consensus on a position statement. RESULTS A total of 323 studies (systematic review and meta-analysis, randomized clinical trial, retrospective comparative cohort studies, case series) have been selected from an initial pool of 7409 studies. Evidence demonstrates several benefits of the laparoscopic approach in stable patients undergoing emergency abdominal surgery for general surgical emergencies or abdominal trauma. The selection of a stable patient seems to be of paramount importance for a safe adoption of a laparoscopic approach. In hemodynamically stable patients, the laparoscopic approach was found to be safe, feasible and effective as a therapeutic tool or helpful to identify further management steps and needs, resulting in improved outcomes, regardless of conversion. Appropriate patient selection, surgeon experience and rigorous minimally invasive surgical training, remain crucial factors to increase the adoption of laparoscopy in emergency general surgery and abdominal trauma. CONCLUSIONS The WSES expert panel suggests laparoscopy as the first approach for stable patients undergoing emergency abdominal surgery for general surgery emergencies and abdominal trauma.
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Affiliation(s)
- Giacomo Sermonesi
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | - Brian W C A Tian
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Carlo Vallicelli
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al‑Ain, United Arab Emirates
| | | | | | - Ari Leppäniemi
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Joseph M Galante
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andrew W Kirkpatrick
- Departments of Surgery and Critical Care Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada
| | - Vladimir Khokha
- Department of Emergency Surgery, City Hospital, Mozyr, Belarus
| | - Oreste Marco Romeo
- Trauma, Burn, and Surgical Care Program, Bronson Methodist Hospital, Kalamazoo, MI, USA
| | - Mircea Chirica
- Department of Digestive Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
| | - Manos Pikoulis
- 3Rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Andrey Litvin
- Department of Surgical Diseases No. 3, Gomel State Medical University, Gomel, Belarus
| | | | - Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Imtiaz Wani
- Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Ibrahima Sall
- General Surgery Department, Military Teaching Hospital, Dakar, Senegal
| | - Paola Fugazzola
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Enrico Cicuttin
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Adriana Toro
- Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Francesco Amico
- Discipline of Surgery, School of Medicine and Public Health, Newcastle, Australia
| | - Francesca Dal Mas
- Department of Management, Ca' Foscari University of Venice, Campus Economico San Giobbe Cannaregio, 873, 30100, Venice, Italy
| | - Belinda De Simone
- Department of Emergency Surgery, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Michael Sugrue
- Donegal Clinical Research Academy Emergency Surgery Outcome Project, Letterkenny University Hospital, Donegal, Ireland
| | - Luigi Bonavina
- Department of Surgery, IRCCS Policlinico San Donato, University of Milano, Milan, Italy
| | | | - Paolo Carcoforo
- Department of Surgery, S. Anna University Hospital and University of Ferrara, Ferrara, Italy
| | - Lorenzo Cobianchi
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Federico Coccolini
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Massimo Chiarugi
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Salomone Di Saverio
- General Surgery Department Hospital of San Benedetto del Tronto, Marche Region, Italy
| | - Mauro Podda
- Department of Surgical Science, Emergency Surgery Unit, University of Cagliari, Cagliari, Italy
| | - Michele Pisano
- General and Emergency Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery, University of Bari "A. Moro", Bari, Italy
| | - Andreas Fette
- Pediatric Surgery, Children's Care Center, SRH Klinikum Suhl, Suhl, Thuringia, Germany
| | - Sandro Rizoli
- Surgery Department, Section of Trauma Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero‑Universitaria Parma, Parma, Italy
| | - Dieter Weber
- Department of Trauma Surgery, Royal Perth Hospital, Perth, Australia
| | - Rifat Latifi
- Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Yoram Kluger
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Zsolt Janos Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Walter Biffl
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Hans Jeekel
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Ian Civil
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Andreas Hecker
- Emergency Medicine Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Luca Ansaloni
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Francesca Bravi
- Healthcare Administration, Santa Maria Delle Croci Hospital, Ravenna, Italy
| | - Vanni Agnoletti
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | | | - Ernest Eugene Moore
- Ernest E Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA
| | - Fausto Catena
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
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Liu Q, Zhang W, Zhao JJ, Syn NL, Cipriani F, Alzoubi M, Aghayan DL, Siow TF, Lim C, Scatton O, Herman P, Coelho FF, Marino MV, Mazzaferro V, Chiow AKH, Sucandy I, Ivanecz A, Choi SH, Lee JH, Prieto M, Vivarelli M, Giuliante F, Dalla Valle B, Ruzzenente A, Yong CC, Chen Z, Yin M, Fondevila C, Efanov M, Morise Z, Di Benedetto F, Brustia R, Dalla Valle R, Boggi U, Geller D, Belli A, Memeo R, Gruttadauria S, Mejia A, Park JO, Rotellar F, Choi GH, Robles-Campos R, Wang X, Sutcliffe RP, Schmelzle M, Pratschke J, Tang CN, Chong CCN, Lee KF, Meurs J, D'Hondt M, Monden K, Lopez-Ben S, Kingham TP, Ferrero A, Ettorre GM, Levi Sandri GB, Saleh M, Cherqui D, Zheng J, Liang X, Mazzotta A, Soubrane O, Wakabayashi G, Troisi RI, Cheung TT, Kato Y, Sugioka A, D'Silva M, Han HS, Nghia PP, Long TCD, Edwin B, Fuks D, Chen KH, Abu Hilal M, Aldrighetti L, Liu R, Goh BKP. Propensity-score Matched and Coarsened-exact Matched Analysis Comparing Robotic and Laparoscopic Major Hepatectomies: An International Multicenter Study of 4822 Cases. Ann Surg 2023; 278:969-975. [PMID: 37058429 DOI: 10.1097/sla.0000000000005855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
OBJECTIVE To compare the outcomes between robotic major hepatectomy (R-MH) and laparoscopic major hepatectomy (L-MH). BACKGROUND Robotic techniques may overcome the limitations of laparoscopic liver resection. However, it is unknown whether R-MH is superior to L-MH. METHODS This is a post hoc analysis of a multicenter database of patients undergoing R-MH or L-MH at 59 international centers from 2008 to 2021. Data on patient demographics, center experience volume, perioperative outcomes, and tumor characteristics were collected and analyzed. Both 1:1 propensity-score matched (PSM) and coarsened-exact matched (CEM) analyses were performed to minimize selection bias between both groups. RESULTS A total of 4822 cases met the study criteria, of which 892 underwent R-MH and 3930 underwent L-MH. Both 1:1 PSM (841 R-MH vs. 841 L-MH) and CEM (237 R-MH vs. 356 L-MH) were performed. R-MH was associated with significantly less blood loss {PSM:200.0 [interquartile range (IQR):100.0, 450.0] vs 300.0 (IQR:150.0, 500.0) mL; P = 0.012; CEM:170.0 (IQR: 90.0, 400.0) vs 200.0 (IQR:100.0, 400.0) mL; P = 0.006}, lower rates of Pringle maneuver application (PSM: 47.1% vs 63.0%; P < 0.001; CEM: 54.0% vs 65.0%; P = 0.007) and open conversion (PSM: 5.1% vs 11.9%; P < 0.001; CEM: 5.5% vs 10.4%, P = 0.04) compared with L-MH. On subset analysis of 1273 patients with cirrhosis, R-MH was associated with a lower postoperative morbidity rate (PSM: 19.5% vs 29.9%; P = 0.02; CEM 10.4% vs 25.5%; P = 0.02) and shorter postoperative stay [PSM: 6.9 (IQR: 5.0, 9.0) days vs 8.0 (IQR: 6.0 11.3) days; P < 0.001; CEM 7.0 (IQR: 5.0, 9.0) days vs 7.0 (IQR: 6.0, 10.0) days; P = 0.047]. CONCLUSIONS This international multicenter study demonstrated that R-MH was comparable to L-MH in safety and was associated with reduced blood loss, lower rates of Pringle maneuver application, and conversion to open surgery.
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Affiliation(s)
- Qu Liu
- The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- Organ Transplantation Department, The Third Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Wanguang Zhang
- Hepatic Surgery Center and Hubei Key Laboratory of Hepato-Biliary-Pancreatic Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Joseph J Zhao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicholas L Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Federica Cipriani
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Davit L Aghayan
- The Intervention Centre and Department of HPB Surgery, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tiing-Foong Siow
- Division of General Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chetana Lim
- Department of Digestive, HBP and Liver Transplantation, Hopital Pitie-Salpetriere, Sorbonne Universite, Paris, France
| | - Olivier Scatton
- 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
| | - Marco V Marino
- General Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy and General Surgery Department, F. Tappeiner Hospital, Merano, Italy
| | - Vincenzo Mazzaferro
- HPB Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano and University of Milan, Milan, Italy
| | - Adrian K H Chiow
- Department of Surgery, Hepatopancreatobiliary Unit, Changi General Hospital, Singapore
| | | | - Arpad Ivanecz
- Department of Abdominal and General Surgery, University Medical Center Maribor, Maribor, Slovenia
| | - Sung-Hoon Choi
- Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jae Hoon Lee
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mikel Prieto
- Hepatobiliary Surgery and Liver Transplantation Unit, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
| | - Marco Vivarelli
- Department of Experimental and Clinical Medicine, HPB Surgery and Transplantation Unit, United Hospital of Ancona, Polytechnic University of Marche, Ancona, Italy
| | - Felice Giuliante
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Bernardo Dalla Valle
- Department of Surgery, Dentistry, Gynecology and Pediatrics, General and Hepatobiliary Surgery, University of Verona, GB Rossi Hospital, Verona, Italy
| | - Andrea Ruzzenente
- Department of Surgery, Dentistry, Gynecology and Pediatrics, General and Hepatobiliary Surgery, University of Verona, GB Rossi Hospital, Verona, Italy
| | - Chee-Chien Yong
- Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Zewei Chen
- Department of Hepatobiliary Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Mengqiu Yin
- Department of Hepatobiliary Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Constantino Fondevila
- General and Digestive Surgery, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain and 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
| | - Zenichi Morise
- Department of Surgery, Okazaki Medical Center, Fujita Health University School of Medicine, Okazaki, Japan
| | - Fabrizio Di Benedetto
- HPB Surgery and Liver Transplant Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Raffaele Brustia
- Department of Digestive and Hepatobiliary and Pancreatic Surgery, AP-HP, Henri-Mondor Hospital, Creteil, France
| | - Raffaele Dalla Valle
- Department of Medicine and Surgery, Hepatobiliary Surgery Unit, University of Parma, Parma, Italy
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - David Geller
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Andrea Belli
- Department of Abdominal Oncology, Division of Hepatopancreatobiliary Surgical Oncology, National Cancer Center-IRCCS-G. Pascale, Naples, Italy
| | - Riccardo Memeo
- Unit of Hepato-Pancreatc-Biliary Surgery, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Salvatore Gruttadauria
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS-ISMETT), University of Pittsburgh Medical Center Italy, Palermo, Italy and Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Alejandro Mejia
- The Liver Institute, Methodist Dallas Medical Center, Dallas, TX
| | - James O Park
- Department of Surgery, University of Washington Medical Center. Seattle, WA
| | - Fernando Rotellar
- Department of General Surgery, HPB and Liver Transplant Unit, Clinica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain 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
| | - 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
| | - Chung-Ngai Tang
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - Charing C N Chong
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
| | - Kit-Fai Lee
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
| | - Juul Meurs
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Mathieu D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Kazuteru Monden
- Department of Surgery, Fukuyama City Hospital, Hiroshima, Japan
| | - Santiago Lopez-Ben
- Department of Surgery, Hepatobiliary and Pancreatic Surgery Unit, Dr. Josep Trueta Hospital, IdIBGi, Girona, Spain
| | | | - 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
| | | | - Mansour Saleh
- 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
| | - Junhao Zheng
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao Liang
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Alessandro Mazzotta
- Department of Digestive, Oncologic and Metabolic Surgery, Institute Mutualiste Montsouris, Universite Paris Descartes, Paris, France
| | - Olivier Soubrane
- Department of Digestive, Oncologic and Metabolic Surgery, Institute Mutualiste Montsouris, Universite Paris Descartes, Paris, France
| | - Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan
| | - Roberto I Troisi
- Division of HPB, Minimally Invasive and Robotic Surgery, Department of Clinical Medicine and Surgery, Federico II University Hospital Naples, Naples, Italy
| | - Tan-To Cheung
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Yutaro Kato
- Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan
| | - Atsushi Sugioka
- Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan
| | - Mizelle D'Silva
- Department of Surgery, Seoul National University Hospital Bundang, Seoul National University College of Medicine, Seoul, Korea
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Hospital Bundang, Seoul National University College of Medicine, Seoul, Korea
| | - Phan Phuoc Nghia
- Department of Hepatopancreatobiliary Surgery, University Medical Center, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Tran Cong Duy Long
- Department of Hepatopancreatobiliary Surgery, University Medical Center, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Bjørn Edwin
- The Intervention Centre and Department of HPB Surgery, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - David Fuks
- Department of Digestive, Oncologic and Metabolic Surgery, Institute Mutualiste Montsouris, Universite Paris Descartes, Paris, France
| | - Kuo-Hsin Chen
- Division of General Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Mohammad Abu Hilal
- Department of Surgery, University Hospital Southampton, United Kingdom and Department of Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - Rong Liu
- The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore
- Duke National University of Singapore Medical School, Singapore
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Ruff SM, Cloyd JM, Pawlik TM. Annals of Surgical Oncology Practice Guidelines Series: Management of Primary Liver and Biliary Tract Cancers. Ann Surg Oncol 2023; 30:7935-7949. [PMID: 37691030 DOI: 10.1245/s10434-023-14255-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/22/2023] [Indexed: 09/12/2023]
Abstract
Primary cancers of the liver and biliary tract are rare and aggressive tumors that often present with locally advanced or metastatic disease. For patients with localized disease amenable to resection, surgery typically offers the best chance at curative-intent therapy. Unfortunately, the incidence of recurrence even after curative-intent surgery remains high. In turn, patients with hepatobiliary cancers commonly require multimodality therapy including a combination of resection, systemic therapy (i.e., targeted therapy, cytotoxic chemotherapy, immunotherapy), and/or loco-regional therapies. With advancements in the field, it is crucial for surgical oncologists to remain updated on the latest guidelines and recommendations for surgical management and optimal patient selection. Given the complex and evolving nature of treatment, this report highlights the latest practice guidelines for the surgical management of hepatobiliary cancers.
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Affiliation(s)
- Samantha M Ruff
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Jordan M Cloyd
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
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25
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Singal AG, Llovet JM, Yarchoan M, Mehta N, Heimbach JK, Dawson LA, Jou JH, Kulik LM, Agopian VG, Marrero JA, Mendiratta-Lala M, Brown DB, Rilling WS, Goyal L, Wei AC, Taddei TH. AASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma. Hepatology 2023; 78:1922-1965. [PMID: 37199193 PMCID: PMC10663390 DOI: 10.1097/hep.0000000000000466] [Citation(s) in RCA: 144] [Impact Index Per Article: 144.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 05/19/2023]
Affiliation(s)
- Amit G. Singal
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Josep M. Llovet
- Liver Cancer Program, Division of Liver Diseases, Tisch Cancer Institute, Mount Sinai School of Medicine, New York, New York, USA
- Translational Research in Hepatic Oncology, Liver Unit, August Pi i Sunyer Biomedical Research Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Catalonia, Spain
| | - Mark Yarchoan
- Department of Medical Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Neil Mehta
- University of California, San Francisco, San Francisco, California, USA
| | | | - Laura A. Dawson
- Radiation Medicine Program/University Health Network, Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Janice H. Jou
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon, USA
| | - Laura M. Kulik
- Northwestern Medical Faculty Foundation, Chicago, Illinois, USA
| | - Vatche G. Agopian
- The Dumont–University of California, Los Angeles, Transplant Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Jorge A. Marrero
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mishal Mendiratta-Lala
- Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Daniel B. Brown
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - William S. Rilling
- Division of Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lipika Goyal
- Department of Medicine, Stanford School of Medicine, Palo Alto, California, USA
| | - Alice C. Wei
- Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Tamar H. Taddei
- Department of Medicine (Digestive Diseases), Yale School of Medicine, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
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Labadie KP, Melstrom LG, Lewis AG. Safe implementation of a minimally invasive hepatopancreatobiliary program, a narrative review and institutional experience. J Surg Oncol 2023; 128:1347-1352. [PMID: 37781938 DOI: 10.1002/jso.27455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/17/2023] [Indexed: 10/03/2023]
Abstract
Laparoscopic and robotic-assisted approaches to hepatopancreatobiliary (HPB) operations have expanded worldwide. As surgeons and medical centers contemplate initiating and expanding minimally invasive surgical (MIS) programs for complex HPB surgical operations, there are many factors to consider. This review highlights the key components of developing an MIS HPB program and shares our recent institutional experience with the adoption and expansion of an MIS approach to pancreaticoduodenectomy.
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Affiliation(s)
- Kevin P Labadie
- Department of Surgery, City of Hope National Medical Center, Division of Surgical Oncology, Duarte, California, USA
| | - Laleh G Melstrom
- Department of Surgery, City of Hope National Medical Center, Division of Surgical Oncology, Duarte, California, USA
| | - Aaron G Lewis
- Department of Surgery, City of Hope National Medical Center, Division of Surgical Oncology, Duarte, California, USA
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Kim SH, Kim KH, Cho HD, Suh KS, Hong SK, Lee KW, Choi GS, Kim JM, Choon Hyuck David K, Cho JY, Han HS, Han J, Han YS. Donor Safety and Risk Factors of Pure Laparoscopic Living Donor Right Hepatectomy: A Korean Multicenter Study. Ann Surg 2023; 278:e1198-e1203. [PMID: 37395608 DOI: 10.1097/sla.0000000000005976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
OBJECTIVE The aim of this study was to identify safety and risk factors of living donor after pure laparoscopic donor right hepatectomy in a Korean multicenter cohort study. BACKGROUND Pure laparoscopic donor right hepatectomy is not yet a standardized surgical procedure due to lack of data. METHODS This retrospective study included 543 patients undergoing PLRDH between 2010 and 2018 in 5 Korean transplantation centers. Complication rates were assessed and multivariate logistic regression analyses were performed to identify risk factors of open conversion, overall complications, major complications, and biliary complications. RESULTS Regarding open conversion, the incidence was 1.7% and the risk factor was body mass index >30 kg/m 2 [ P =0.001, odds ratio (OR)=22.72, 95% CI=3.56-146.39]. Rates of overall, major (Clavien-Dindo classification III-IV), and biliary complications were 9.2%, 4.4%, and 3.5%, respectively. For overall complications, risk factors were graft weight >700 g ( P =0.007, OR=2.66, 95% CI=1.31-5.41), estimated blood loss ( P <0.001, OR=4.84, 95% CI=2.50-9.38), and operation time >400 minutes ( P =0.01, OR=2.46, 95% CI=1.25-4.88). For major complications, risk factors were graft weight >700 g ( P =0.002, OR=4.01, 95% CI=1.67-9.62) and operation time >400 minutes ( P =0.003, OR=3.84, 95% CI=1.60-9.21). For biliary complications, risk factors were graft weight >700 g ( P =0.01, OR=4.34, 95% CI=1.40-13.45) and operation time >400 minutes ( P =0.01, OR=4.16, 95% CI=1.34-12.88). CONCLUSION Careful donor selection for PLRDH considering body mass index, graft weight, estimated blood loss, and operation time combined with skilled procedure can improve donor safety.
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Affiliation(s)
- Sang-Hoon Kim
- Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ki-Hun Kim
- Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hwui-Dong Cho
- Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Suk Kyun Hong
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kwon Choon Hyuck David
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jaryung Han
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook, National University Hospital, Daegu, Republic of Korea
- Department of Surgery, Daegu Catholic University Hospital, School of Medicine Catholic University of Daegu, Daegu, Republic of Korea
| | - Young Seok Han
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook, National University Hospital, Daegu, Republic of Korea
- Department of Surgery, Daegu Catholic University Hospital, School of Medicine Catholic University of Daegu, Daegu, Republic of Korea
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Gudmundsdottir H, Fiorentini G, Essaji Y, D'Souza D, Torres-Ruiz T, Geller DA, Helton WS, Hogg ME, Iannitti DA, Kamath AS, Onkendi EO, Serrano PE, Simo KA, Sucandy I, Warner SG, Alseidi A, Cleary SP. Circumstances and implications of conversion from minimally invasive to open liver resection: a multi-center analysis from the AMILES registry. Surg Endosc 2023; 37:9201-9207. [PMID: 37845532 DOI: 10.1007/s00464-023-10431-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/31/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Minimally invasive approaches to liver resection (MILR) are associated with favorable outcomes. The aim of this study was to determine the implications of conversion to an open procedure on perioperative outcomes. METHODS Patients who underwent MILR at 10 North American institutions were identified from the Americas Minimally Invasive Liver Resection (AMILES) database. Outcomes of patients who required conversion were compared to those who did not. Additionally, outcomes after conversion due to unfavorable findings (poor visualization/access, lack of progress, disease extent) versus intraoperative events (bleeding, injury, cardiopulmonary instability) were compared. RESULTS Of 1675 patients who underwent MILR, 102 (6.1%) required conversion. Conversion rate ranged from 4.4% for left lateral sectionectomy to 10% for right hepatectomy. The primary reason for conversion was unfavorable findings in 67 patients (66%) and intraoperative adverse events in 35 patients (34%). By multivariable analysis, major resection, cirrhosis, prior liver surgery, and tumor proximity to major vessels were identified as risk factors for conversion (p < 0.05). Patients who required conversion had higher blood loss, transfusion requirements, operative time, and length of stay, (p < 0.05). They also had higher major complication rates (23% vs. 5.2%, p < 0.001) and 30-day mortality (8.8% vs. 1.3%, p < 0.001). When compared to those who required conversion due to unfavorable findings, patients who required conversion due to intraoperative adverse events had significantly higher major complication rates (43% vs. 14%, p = 0.012) and 30-day mortality (20% vs. 3.0%, p = 0.007). CONCLUSIONS Conversion from MILR to open surgery is associated with increased perioperative morbidity and mortality. Conversion due to intraoperative adverse events is rare but associated with significantly higher complication and mortality rates, while conversion due to unfavorable findings is associated with similar outcomes as planned open resection. High-risk patients may benefit from early conversion in a controlled fashion if difficulties are encountered or anticipated.
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Affiliation(s)
| | - Guido Fiorentini
- Department of Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | | | | | | | - David A Geller
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | | | | | | | - Edwin O Onkendi
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | | | | | | | - Susanne G Warner
- Department of Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Adnan Alseidi
- Virginia Mason Medical Center, Seattle, WA, USA
- University of California San Francisco, San Francisco, CA, USA
| | - Sean P Cleary
- Department of Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
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Tao H, Wang Z, Zeng X, Hu H, Li J, Lin J, Lin W, Fang C, Yang J. Augmented Reality Navigation Plus Indocyanine Green Fluorescence Imaging Can Accurately Guide Laparoscopic Anatomical Segment 8 Resection. Ann Surg Oncol 2023; 30:7373-7383. [PMID: 37606841 DOI: 10.1245/s10434-023-14126-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/27/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Laparoscopic anatomical Segment 8 (S8) resection is a highly challenging hepatectomy. Augmented reality navigation (ARN), which could be combined with indocyanine green (ICG) fluorescence imaging, has been applied in various complex liver resections and may also be applied in laparoscopic anatomical S8 resection. However, no study has explored how to apply ARN plus ICG fluorescence imaging (ARN-FI) in laparoscopic anatomical S8 resection, or explored its accuracy. PATIENTS AND METHODS This study is a post hoc analysis that included 31 patients undergoing laparoscopic anatomical S8 resection from the clinical NaLLRFI trial, and the resected liver volume was measured in each patient. The perioperative parameters of safety and feasibility, as well as the accuracy analysis outcomes were compared. RESULTS There were 16 patients in the ARN-FI group and 15 patients underwent conventional laparoscopic hepatectomy without ARN or fluorescence imaging (non-ARN-FI group). There was no significant difference in baseline characteristics between the two groups. Compared with the non-ARN-FI group, the ARN-FI group had lower intraoperative bleeding (median 125 vs. 300 mL, P = 0.003). No significant difference was observed in other postoperative short-term outcomes. Accuracy analysis indicated that the actual resected liver volume (ARLV) in the ARN-FI group was more accurate. CONCLUSIONS ARN-FI was associated with less intraoperative bleeding and more accurate resection volume. These techniques may address existing challenges and provide rational guidance for laparoscopic anatomical S8 resection.
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Affiliation(s)
- Haisu Tao
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China
| | - Zhuangxiong Wang
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China
| | - Xiaojun Zeng
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China
| | - Haoyu Hu
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China
| | - Jiang Li
- The First Affiliated Hospital, College of Medicine, Shihezi University, Shihezi, China
| | - Jinyu Lin
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China
| | - Wenjun Lin
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China
| | - Chihua Fang
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China.
- Pazhou Lab, Guangzhou, China.
| | - Jian Yang
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China.
- Pazhou Lab, Guangzhou, China.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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He ZW, Wang C, Li Y, Danzeng A, Liu FB, Zhu Y, Shi JY, Ciren P, Yuan XY, Wu CX, Lan RH, Zhang BH. The state of female hepato-pancreato-biliary (HPB) surgeons in China: see us in operation theater with great prospects. HPB (Oxford) 2023; 25:1402-1410. [PMID: 37543474 DOI: 10.1016/j.hpb.2023.07.884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/02/2023] [Accepted: 07/12/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE This study aims to investigate the proportion and distribution of female HPB surgeons in China, describe their current status, and analyze the possible barriers and challenges in their careers. METHOD Tertiary hospitals with the division of HPB in mainland China in 2021 were enrolled and surgeon demographic information was collected through the review of official websites and/or telephone interviews. RESULTS The majority of female HPB surgeons (72.92%) were located in the first or second-tier cities in mainland China, with an increasing number of new female HPB surgeons entering the field annually, particularly after 2005 (from 27 to 52 per 5 years). Despite no significant difference in academic backgrounds, female HPB surgeons initiated their careers at an earlier age and took a longer time to obtain chief titles (P < 0.05). Interestingly, female HPB surgeons performed laparoscopic complex HPB cases at a similar rate (95.42%) to their male counterparts and were more likely to specialize in endoscopic surgery (P = 0.021), with a similar ratio of obtaining administrative positions. CONCLUSION Minimally invasive surgery may provide females with unprecedented opportunities in the HPB surgery field. However, despite the increasing numbers of female HPB surgeons, the proportion remains low in China.
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Affiliation(s)
- Zheng-Wei He
- Hepatic Surgery Center, Institute of Hepato-pancreato-biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China; Division of Hepato-pancreato-biliary Surgery, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, 430064, China
| | - Chao Wang
- Hepatic Surgery Center, Institute of Hepato-pancreato-biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yong Li
- Division of Hepato-pancreato-biliary Surgery, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, 430064, China
| | - Awang Danzeng
- Hepatic Surgery Center, Institute of Hepato-pancreato-biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Fu-Bin Liu
- Division of Hepato-pancreato-biliary Surgery, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, 430064, China
| | - Yuan Zhu
- School of Automation, China University of Geosciences, Wuhan, 430074, China
| | - Jia-Yu Shi
- Division of Hepato-pancreato-biliary Surgery, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, 430064, China
| | - Pingcuo Ciren
- Hepatic Surgery Center, Institute of Hepato-pancreato-biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiao-Yin Yuan
- Division of Hepato-pancreato-biliary Surgery, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, 430064, China
| | - Cheng-Xian Wu
- Division of Hepato-pancreato-biliary Surgery, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, 430064, China
| | - Run-Hu Lan
- Division of Hepato-pancreato-biliary Surgery, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, 430064, China
| | - Bin-Hao Zhang
- Hepatic Surgery Center, Institute of Hepato-pancreato-biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China; Division of Hepato-pancreato-biliary Surgery, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, 430064, China.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Pascale MM, Ratti F, Cipriani F, Marino R, Catena M, Clocchiatti L, Buonanno S, Aldrighetti L. A "cui prodest" evaluation on the development of a minimally invasive liver surgery program: a differential benefit analysis of open and laparoscopic approach for left and right hemihepatectomies. Surg Endosc 2023; 37:8204-8213. [PMID: 37648797 DOI: 10.1007/s00464-023-10382-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/06/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND The correlation between technical feasibility and short-term clinical advantage provided by laparoscopic over open technique for major hepatectomies is unclear. This monocentric retrospective study investigates the possible differences in the benefit provided by minimally invasive approach between left and right hepatectomy, deepening the concept of differential benefit in the setting of anatomical major resections. METHODS All hemihepatectomies performed from January 2004 to December 2021 were identified in the institutional database. A propensity score method was used to match minimal invasive (MILS) and open pairs in the left hemihepatectomies (LH) and right hemihepatectomies (RH) groups with a 1:1 ratio to adjust any potential selection bias. The differential benefit for left and right hepatectomy provided by laparoscopic over open technique was evaluated in a pure analysis (i.e., including cases converted to open) and a risk-adjusted analysis (i.e., after excluding open conversion from the laparoscopic series). RESULTS The analysis of the risk-adjusted differential benefit demonstrated better result of the MILS in the RH group than in the LH group, in terms of blood loss (∆ blood loss - 150 and - 350, respectively; differential benefit: 200 mL, p < 0.05), morbidity (∆ rate of morbidity - 11.3% and - 18.1%, respectively; differential benefit: 6.8%, p < 0.05) and length of stay, LOS (∆ LOS - 1 day and - 3 days, respectively; differential benefit: 2 days, p < 0.05). CONCLUSION While MILS is associated with improved clinical outcomes both in left and right hepatectomy procedures, the greater advantage provided by laparoscopy was documented in patients undergoing right hepatectomy, i.e. for more technically demanding procedures. A MILS program should include the broadest range of liver resections to ensure the full benefits of the laparoscopic technique.
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Affiliation(s)
- Marco Maria Pascale
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132, Milan, Italy
| | - Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132, Milan, Italy.
- Faculty of Medicine, University Vita-Salute San Raffaele, 20132, Milan, Italy.
| | - Federica Cipriani
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132, Milan, Italy
| | - Rebecca Marino
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132, Milan, Italy
| | - Marco Catena
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132, Milan, Italy
| | - Lucrezia Clocchiatti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132, Milan, Italy
| | - Silvia Buonanno
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132, Milan, Italy
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132, Milan, Italy
- Faculty of Medicine, University Vita-Salute San Raffaele, 20132, Milan, Italy
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Goodsell KE, Park JO. Robotic hepatectomy: current evidence and future directions. Minerva Surg 2023; 78:525-536. [PMID: 36946128 DOI: 10.23736/s2724-5691.23.09858-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Minimally invasive hepatectomy continues to gain popularity and acceptance for treatment of benign and malignant liver disease. Robotic hepatectomy offers potential advantages over open and conventional laparoscopic approaches. Review of the literature on robotic hepatectomy was performed. Search terms included "robotic hepatectomy" and "minimally invasive hepatectomy." Search was further customized to include articles related to robotic surgical technology. Across many parameters in liver surgery, robotic liver resection appears to have comparable outcomes with respect to laparoscopic resection. The benefits over open resection are largely related to less morbidity and faster recovery times. There is evidence that the robotic approach may have a shorter learning curve and enable more difficult resections to be performed minimally invasively. The robotic platform may have the potential to achieve superior margin status or parenchymal sparing resection in oncologic resections, but numerous obstacles remain. The robotic platform has not been applied to liver surgery to the same extent as either laparoscopic or open surgery. Robotic surgical technology will need to continue developing to deliver on its potential advantages.
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Affiliation(s)
| | - James O Park
- Department of Surgery, University of Washington, Seattle, WA, USA
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Kikuchi K, Nitta H, Umemura A, Katagiri H, Kanno S, Takeda D, Ando T, Amano S, Sasaki A. Risk-Adjusted Assessment of the Learning Curve for Pure Laparoscopic Donor Hepatectomy for Adult Recipients. World J Surg 2023; 47:2488-2498. [PMID: 37326677 DOI: 10.1007/s00268-023-07089-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Studies on pure laparoscopic donor hepatectomy (PLDH) have been reported. However, only few studies have reported on the learning curve of PLDH. In this report, we aimed to determine the learning curve of PLDH in adult patients using cumulative sum (CUSUM) and risk-adjusted CUSUM (RA-CUSUM) analyses. METHODS The data of donors who underwent PLDH at a single center between December 2012 and May 2022 were retrospectively reviewed. The learning curve was evaluated using the CUSUM and RA-CUSUM methods based on surgery duration. RESULTS Forty-eight patients were finally included in the present study. The mean operation time was 393.6 ± 80.3 min. PLDH was converted to laparotomy in three cases (6.3%). According to the Clavien-Dindo classification, nine cases (18.8%) had higher-than-grade III postoperative complications and the most frequent complications were biliary complications. The CUSUM graph shows two peaks, at the 13th and 27th case. The multivariate analysis revealed that a body mass index ≥ 23 kg/m2 and intraoperative cholangiography were the only factors that were independently associated with longer operation time. Based on these results, an RA-CUSUM analysis was performed to assess the learning curve, which showed a decrease in the learning curve after 33 to 34 PLDH procedures. CONCLUSIONS A learning curve effect was demonstrated in this study after 33 to 34 PLDH procedures. There are relatively many biliary complications, and it is necessary to further examine the method of bile duct transection.
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Affiliation(s)
- Koji Kikuchi
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Iwate, 028-3695, Japan.
| | - Hiroyuki Nitta
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Iwate, 028-3695, Japan
| | - Akira Umemura
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Iwate, 028-3695, Japan
| | - Hirokatsu Katagiri
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Iwate, 028-3695, Japan
| | - Shoji Kanno
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Iwate, 028-3695, Japan
| | - Daiki Takeda
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Iwate, 028-3695, Japan
| | - Taro Ando
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Iwate, 028-3695, Japan
| | - Satoshi Amano
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Iwate, 028-3695, Japan
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Iwate, 028-3695, Japan
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Lim C, Scatton O, Wu AGR, Zhang W, Hasegawa K, Cipriani F, Sijberden J, Aghayan DL, Siow TF, Dokmak S, Herman P, Marino MV, Mazzaferro V, Chiow AKH, Sucandy I, Ivanecz A, Choi SH, Lee JH, Prieto M, Vivarelli M, Giuliante F, Ruzzenente A, Yong CC, Yin M, Fondevila C, Efanov M, Morise Z, Di Benedetto F, Brustia R, Dalla Valle R, Boggi U, Geller D, Belli A, Memeo R, Gruttadauria S, Mejia A, Park JO, Rotellar F, Choi GH, Robles-Campos R, Wang X, Sutcliffe RP, Pratschke J, Lai ECH, Chong CCN, D'Hondt M, Monden K, Lopez-Ben S, Kingham TP, Ferrero A, Ettorre GM, Cherqui D, Liang X, Soubrane O, Wakabayashi G, Troisi RI, Cheung TT, Sugioka A, Han HS, Long TCD, Liu R, Edwin B, Fuks D, Chen KH, Abu Hilal M, Aldrighetti L, Goh BKP. Impact of liver cirrhosis and portal hypertension on minimally invasive limited liver resection for primary liver malignancies in the posterosuperior segments: An international multicenter study. Eur J Surg Oncol 2023; 49:106997. [PMID: 37591027 PMCID: PMC10866151 DOI: 10.1016/j.ejso.2023.106997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/29/2023] [Accepted: 07/26/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION To assess the impact of cirrhosis and portal hypertension (PHT) on technical difficulty and outcomes of minimally invasive liver resection (MILR) in the posterosuperior segments. METHODS This is a post-hoc analysis of patients with primary malignancy who underwent laparoscopic and robotic wedge resection and segmentectomy in the posterosuperior segments between 2004 and 2019 in 60 centers. Surrogates of difficulty (i.e, open conversion rate, operation time, blood loss, blood transfusion, and use of the Pringle maneuver) and outcomes were compared before and after propensity-score matching (PSM) and coarsened exact matching (CEM). RESULTS Of the 1954 patients studied, 1290 (66%) had cirrhosis. Among the cirrhotic patients, 310 (24%) had PHT. After PSM, patients with cirrhosis had higher intraoperative blood transfusion (14% vs. 9.3%; p = 0.027) and overall morbidity rates (20% vs. 14.5%; p = 0.023) than those without cirrhosis. After coarsened exact matching (CEM), patients with cirrhosis tended to have higher intraoperative blood transfusion rate (12.1% vs. 6.7%; p = 0.059) and have higher overall morbidity rate (22.8% vs. 12.5%; p = 0.007) than those without cirrhosis. After PSM, Pringle maneuver was more frequently applied in cirrhotic patients with PHT (62.2% vs. 52.4%; p = 0.045) than those without PHT. CONCLUSION MILR in the posterosuperior segments in cirrhotic patients is associated with higher intraoperative blood transfusion and postoperative morbidity. This parameter should be utilized in the difficulty assessment of MILR.
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Affiliation(s)
- Chetana Lim
- Department of Digestive, HBP and Liver Transplantation, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Olivier Scatton
- Department of Digestive, HBP and Liver Transplantation, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Andrew G R Wu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wanguang Zhang
- Hepatic Surgery Center and Hubei Key Laboratory of Hepato-Biliary-Pancreatic Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Federica Cipriani
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Davit L Aghayan
- The Intervention Centre and Department of HPB Surgery, Oslo University Hospital, Institute of Clincal Medicine, University of Oslo, Oslo, Norway
| | - Tiing-Foong Siow
- Division of General Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Safi Dokmak
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, University Paris Cite, Clichy, France
| | - Paulo Herman
- Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Marco V Marino
- General Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy; General Surgery Department, F. Tappeiner Hospital, Merano, Italy
| | - Vincenzo Mazzaferro
- HPB Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano and University of Milan, Milan, Italy
| | - Adrian K H Chiow
- Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital, Singapore
| | - Iswanto Sucandy
- Digestive Health Institute, AdventHealth Tampa, Tampa, FL, USA
| | - Arpad Ivanecz
- Department of Abdominal and General Surgery, University Medical Center Maribor, Maribor, Slovenia
| | - Sung-Hoon Choi
- Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Jae Hoon Lee
- Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Mikel Prieto
- Hepatobiliary Surgery and Liver Transplantation Unit, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
| | - Marco Vivarelli
- HPB Surgery and Transplantation Unit, United Hospital of Ancona, Department of Experimental and Clinical Medicine Polytechnic University of Marche, Ancona, Italy
| | - Felice Giuliante
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Andrea Ruzzenente
- General and Hepatobiliary Surgery, Department of Surgery, Dentistry, Gynecology and Pediatrics University of Verona, GB Rossi Hospital, Verona, Italy
| | - Chee-Chien Yong
- Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Mengqiu Yin
- Department of Hepatobiliary Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - 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
| | - Zenichi Morise
- Department of Surgery, Okazaki Medical Center, Fujita Health University School of Medicine, Okazaki, Japan
| | - Fabrizio Di Benedetto
- HPB Surgery and Liver Transplant Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Raffaele Brustia
- Department of Digestive and Hepatobiliary and Pancreatic Surgery, AP-HP, Henri-Mondor Hospital, Creteil, France
| | - Raffaele Dalla Valle
- Hepatobiliary Surgery Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - David Geller
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Andrea Belli
- Department of Abdominal Oncology, Division of Hepatopancreatobiliary Surgical Oncology, National Cancer Center - IRCCS-G. Pascale, Naples, Italy
| | - Riccardo Memeo
- Unit of Hepato-Pancreatc-Biliary Surgery, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Salvatore Gruttadauria
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS-ISMETT), University of Pittsburgh Medical Center Italy, Palermo, Italy; Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Alejandro Mejia
- The Liver Institute, Methodist Dallas Medical Center, Dallas, TX, USA
| | - James O Park
- Department of Surgery, University of Washington Medical Center, Seattle, USA
| | - Fernando Rotellar
- HPB 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
| | - Gi-Hong Choi
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South 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, United Kingdom
| | - 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
| | - Eric C H Lai
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Charing C N Chong
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong, China
| | - Mathieu D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Kazuteru Monden
- Department of Surgery, Fukuyama City Hospital, Hiroshima, Japan
| | - Santiago Lopez-Ben
- Hepatobiliary and Pancreatic Surgery Unit, Department of Surgery, Dr. Josep Trueta Hospital, IdIBGi, Girona, Spain
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - 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
| | - Daniel Cherqui
- Department of Hepatobiliary Surgery, Assistance Publique Hopitaux de Paris, Centre Hepato-Biliaire, Paul-Brousse Hospital, Villejuif, France
| | - Xiao Liang
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Olivier Soubrane
- Department of Digestive, Oncologic and Metabolic Surgery, Institute Mutualiste Montsouris, Universite Paris Descartes, Paris, France
| | - Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan
| | - Roberto I Troisi
- Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, Federico II University Hospital Naples, Naples, Italy
| | - Tan-To Cheung
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Atsushi Sugioka
- Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Hospital Bundang, Seoul National University College of Medicine, Seoul, South Korea
| | - Tran Cong Duy Long
- Department of Hepato-Pancreato-Biliary Surgery, University Medical Center Ho Chi Minh City, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Rong Liu
- Faculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Bjørn Edwin
- The Intervention Centre and Department of HPB Surgery, Oslo University Hospital, Institute of Clincal Medicine, University of Oslo, Oslo, Norway
| | - David Fuks
- Department of Digestive, Oncologic and Metabolic Surgery, Institute Mutualiste Montsouris, Universite Paris Descartes, Paris, France
| | - Kuo-Hsin Chen
- Division of General Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Division of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan
| | - Mohammad Abu Hilal
- Department of Surgery, University Hospital Southampton, United Kingdom; Department of Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore; Surgery Academic Clinical Programme, Duke-National University of Singapore Medical School, Singapore.
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Yang SY, Feng JK, Yan ML, Guo L, Duan YF, Ye JZ, Liu ZH, Xiang YJ, Xu L, Xue J, Shi J, Lau WY, Cheng SQ, Guo WX. Laparoscopic and open liver resection for hepatocellular carcinoma with type 2 diabetes mellitus: multicenter propensity score-matched study. Hepatol Int 2023; 17:1251-1264. [PMID: 37060489 DOI: 10.1007/s12072-023-10492-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/20/2023] [Indexed: 04/16/2023]
Abstract
PURPOSE This study aimed at analyzing and comparing the perioperative results and long-term oncological outcomes of hepatocellular carcinoma (HCC) patients with type 2 diabetes mellitus (T2DM) treated with laparoscopic (LLR) versus open liver resection (OLR). METHODS Clinicopathological data of HCC patients with T2DM who underwent LLR or OLR as initial treatment from four medical centers were retrospectively reviewed. The survival outcomes of patients who underwent laparoscopic liver resection (LLR) were compared with those of patients who underwent open liver resection (OLR). Using the Kaplan-Meier method, survival curves for the two groups of patients were generated, and the log-rank test was used to compare survival differences. Propensity score matching (PSM) analysis was used to match patients of the LLR and OLR groups in a 1:1 ratio. RESULTS 230 HCC patients with T2DM were enrolled, including 101 patients in the LLR group and 129 patients in the OLR group. After PSM, 90 patients were matched in each of the study group. Compared with the OLR group, the LLR group had less blood loss, a shorter hospitalization and fewer postoperative complications. The LLR group had a significantly better overall survival (OS) and recurrence-free survival (RFS) than the OLR group before and after PSM. Subgroup analysis demonstrated that HCC patients with T2DM had survival benefits from LLR regardless of the course of T2DM. CONCLUSIONS Laparoscopic liver resection for HCC patients with T2DM can be safely performed with favorable perioperative and long-term oncological outcomes at high-volume liver cancer centers, regardless of the course of T2DM.
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Affiliation(s)
- Shi-Ye Yang
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, China
| | - Jin-Kai Feng
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, China
| | - Mao-Lin Yan
- Department of Hepatobiliary and Pancreatic Surgery, Fujian Provincial Hospital, The Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Lei Guo
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, China
| | - Yun-Fei Duan
- Department of Hepatobiliary and Pancreatic Surgery, The Third Affiliated Hospital of Soochow University (Changzhou People's Hospital), Jiangsu, China
| | - Jia-Zhou Ye
- Department of Hepatobiliary Pancreatic Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Guangxi, China
| | - Zong-Han Liu
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, China
| | - Yan-Jun Xiang
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, China
| | - Li Xu
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Jie Xue
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, China
| | - Jie Shi
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, China
| | - Wan Yee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Shu-Qun Cheng
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, China.
| | - Wei-Xing Guo
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, China.
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Poggi C, Cifone T, Peralta L, d'Angelo T, Mazza O, Sánchez Clariá R, de Santibañes M, Pekolj J. Laparoscopic liver resections: What have we learned after more than 20 years of experience? Cir Esp 2023; 101:678-683. [PMID: 37088364 DOI: 10.1016/j.cireng.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/01/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION The aim of this study is to describe our experience in the last 8 years of laparoscopic liver resections (LLR) for benign and malignant tumors, to evaluate indications and results, and to compare the results with our previous experience and with other reference centers worldwide. METHODS Based on a prospective database of the Hepatopancreatobiliary Surgery and Liver Transplantation Unit of the Hospital Italiano de Buenos Aires, patients who underwent LLR between September 2014 and June 2022 were retrospectively analyzed (period B) and where compared to our own experience from 2000 to 2014 previously published (period A). RESULTS Colorectal liver metastasis was the main indication for surgery (26.4%). Major hepatectomies accounted for 15.7% of resections and the most frequently performed procedure was typical and atypical hepatectomies (58.4%) followed by left lateral hepatectomy (20.3%). The total postoperative major complications rate was 10.1% and the 90-day postoperative mortality was 1%. The median postoperative stay was four (IQR: 3-6) days. The overall survival rate estimated at 1, 3 and 5 years was 94%, 84% and 70%, respectively, with a median follow-up of 22.9 months. CONCLUSIONS LLRs in the hands of trained surgeons continue to grow safely, and we have seen an increase in the indication of LLR for malignant pathologies and major resections, a trend that follows the rest of the major centers in the world and has become the method of choice for surgical treatment of most liver tumors.
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Affiliation(s)
- Catalina Poggi
- Servicio de Cirugía General, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Tomás Cifone
- Servicio de Cirugía General, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Luciana Peralta
- Servicio de Cirugía General, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Tomás d'Angelo
- Servicio de Cirugía General, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Oscar Mazza
- Servicio de Cirugía General, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Rodrigo Sánchez Clariá
- Servicio de Cirugía General, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Martín de Santibañes
- Servicio de Cirugía General, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Juan Pekolj
- Servicio de Cirugía General, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina; Unidad de Cirugía Hepatopancreatobiliar y Trasplante Hepático, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
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Alomari MAM, Wakabayashi T, Colella M, Mishima K, Fujiyama Y, Ababneh E, Wakabayashi G. Comparing the accuracy of positive and negative indocyanine green staining in guiding laparoscopic anatomical liver resection: protocol for a randomised controlled trial. BMJ Open 2023; 13:e072926. [PMID: 37730389 PMCID: PMC10514659 DOI: 10.1136/bmjopen-2023-072926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 08/26/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION Knowledge of the clinical liver anatomy has evolved with advanced imaging modalities and laparoscopic surgery. Therefore, precise anatomical resection knowledge has become the standard treatment for primary and secondary liver cancer. Segmentectomy, a parenchymal-preserving approach, is regarded as an option for anatomical resections in patients with impaired liver. Indocyanine green (ICG) staining is a promising method for understanding the anatomical borders of the liver segments. There are two methods of ICG staining (positive and negative), and the superiority of either approach has not been determined to date. METHODS AND ANALYSIS This is a prospective randomised controlled superiority clinical trial performed in a single centre tertiary hospital in Japan. A comparison between the accuracy of positive and negative ICG staining in guiding laparoscopic anatomical liver resection is planned in this study. Possible candidates are patients with liver malignant tumours in whom laparoscopic monosegmentectomy or subsegmentectomy is planned. Fifty patients will be prospectively allocated into the following two groups: group A, ICG-negative staining group, and group B, ICG-positive staining group. The optimal dose of ICG for positive staining will be determined during the preparation phase. To assess the ability of the ICG fluorescence guidance in anatomical resection, the primary endpoint is the success rate of ICG staining, which consists of a SOS based on three components: superficial demarcation in the liver surface, visualisation of the parenchymal borders and consistency with the preoperative three-dimensional simulation. The secondary endpoints are the evaluation of short-term surgical outcomes and recurrence-free survival. ETHICS AND DISSEMINATION The study was approved by Ageo Central General Hospital Clinical Research Ethical Committee (No: 1044) and it carried out following the Declaration of Helsinki (2013 revision). Informed consent will be taken from the patients before participating. The findings will be disseminated through peer-reviewed publications, scientific meetings and conferences. TRIAL REGISTRATION NUMBER UMIN000049815.
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Affiliation(s)
| | - Taiga Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Ageo, Japan
| | - Marco Colella
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Ageo, Japan
| | - Kouhei Mishima
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Ageo, Japan
| | - Yoshiki Fujiyama
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Ageo, Japan
| | - Ebaa Ababneh
- Physiology and Biochemistry Department, Jordan University of Science and Technology, Irbid, Jordan
| | - Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Ageo, Japan
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Tokumitsu Y, Nagano H, Yamashita YI, Yoshizumi T, Hisaka T, Nanashima A, Kuroki T, Ide T, Endo Y, Utsunomiya T, Kitahara K, Kawasaki Y, Sakota M, Okamoto K, Takami Y, Kajiwara M, Takatsuki M, Beppu T, Eguchi S. Efficacy of laparoscopic liver resection for small hepatocellular carcinoma located in the posterosuperior segments: A multi-institutional study using propensity score matching by the Kyushu Study Group of Liver Surgery. Hepatol Res 2023; 53:878-889. [PMID: 37255386 DOI: 10.1111/hepr.13929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/29/2023] [Accepted: 05/02/2023] [Indexed: 06/01/2023]
Abstract
AIM Laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) located in the posterosuperior segments (PS) have generally been considered more difficult than those for HCC in anterolateral segments (AL), but may be safe and feasible for selected patients with accumulated experience. In the present study, we investigated the effectiveness of LLR for single nodular HCCs ≤3 cm located in PS. METHODS In total, 473 patients who underwent partial liver resection for single nodular HCCs ≤3 cm at the 18 institutions belonging to the Kyusyu Study Group of Liver Surgery from January 2010 to December 2018 were enrolled. The short-term outcomes of laparoscopic partial liver resection and open liver resection (OLR) for HCCs ≤3 cm, with subgroup analysis of PS and AL, were compared using propensity score-matching analysis. Furthermore, results were also compared between LLR-PS and LLR-AL. RESULTS The original cohort of patients with HCC ≤3 cm included 328 patients with LLR and 145 with OLR. After matching, 140 patients with LLR and 140 with OLR were analyzed. Significant differences were found between groups in terms of volume of blood loss (median, 55 vs. 287 ml, p < 0.001), postoperative complications (0.71 vs. 8.57%, p = 0.003), and postoperative hospital stay (median, 9 vs. 14 days, p < 0.001). The results of subgroup analysis of PS were similar. Short-term outcomes did not differ significantly between LLR-PS and LLR-AL after matching. CONCLUSIONS Laparoscopic partial resection could be the preferred option for single nodular HCCs ≤3 cm located in PS.
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Affiliation(s)
- Yukio Tokumitsu
- Kyusyu Study Group of Liver Surgery, Fukuoka, Japan
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Hiroaki Nagano
- Kyusyu Study Group of Liver Surgery, Fukuoka, Japan
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Yo-Ichi Yamashita
- Kyusyu Study Group of Liver Surgery, Fukuoka, Japan
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Tomoharu Yoshizumi
- Kyusyu Study Group of Liver Surgery, Fukuoka, Japan
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toru Hisaka
- Kyusyu Study Group of Liver Surgery, Fukuoka, Japan
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Kurume University, Kurume, Japan
| | - Atsushi Nanashima
- Kyusyu Study Group of Liver Surgery, Fukuoka, Japan
- Division of Hepato-Biliary-Pancreas Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Tamotsu Kuroki
- Kyusyu Study Group of Liver Surgery, Fukuoka, Japan
- Clinical Research Center and Department of Surgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Takao Ide
- Kyusyu Study Group of Liver Surgery, Fukuoka, Japan
- Department of Surgery, Saga University Faculty of Medicine, Saga, Japan
| | - Yuichi Endo
- Kyusyu Study Group of Liver Surgery, Fukuoka, Japan
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine Graduate School of Medicine, Oita, Japan
| | - Tohru Utsunomiya
- Kyusyu Study Group of Liver Surgery, Fukuoka, Japan
- Department of Surgery, Oita Prefectural Hospital, Oita, Japan
| | - Kenji Kitahara
- Kyusyu Study Group of Liver Surgery, Fukuoka, Japan
- Department of Surgery, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Yota Kawasaki
- Kyusyu Study Group of Liver Surgery, Fukuoka, Japan
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medicine, Kagoshima University, Kagoshima, Japan
| | - Masahiko Sakota
- Kyusyu Study Group of Liver Surgery, Fukuoka, Japan
- Department of Surgery, Kagoshima Kouseiren Hospital, Kagoshima, Japan
| | - Kohji Okamoto
- Kyusyu Study Group of Liver Surgery, Fukuoka, Japan
- Department of Surgery, Gastroenterology and Hepatology Center, Kitakyushu City Yahata Hospital, Kitakyushu, Japan
| | - Yuko Takami
- Kyusyu Study Group of Liver Surgery, Fukuoka, Japan
- Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Masatoshi Kajiwara
- Kyusyu Study Group of Liver Surgery, Fukuoka, Japan
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Mitsuhisa Takatsuki
- Kyusyu Study Group of Liver Surgery, Fukuoka, Japan
- Department of Digestive and General Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Toru Beppu
- Kyusyu Study Group of Liver Surgery, Fukuoka, Japan
- Department of Surgery, Yamaga City Medical Center, Yamaga, Japan
| | - Susumu Eguchi
- Kyusyu Study Group of Liver Surgery, Fukuoka, Japan
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Ricker AB, Davis JM, Motz BM, Watson M, Beckman M, Driedger M, Martinie JB, Vrochides D. External validation of the Japanese difficulty score for laparoscopic hepatectomy in patients undergoing robotic-assisted hepatectomy. Surg Endosc 2023; 37:7288-7294. [PMID: 37558825 DOI: 10.1007/s00464-023-10330-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/19/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION The Japanese difficulty score (JDS) categorizes laparoscopic hepatectomy into low, intermediate, and high complexity procedures, and correlates with operative and postoperative outcomes. We sought to perform a validation study to determine if the JDS correlates with operative and postoperative indicators of surgical complexity for patients undergoing robotic-assisted hepatectomy. METHODS Retrospective review of 657 minimally invasive hepatectomy procedures was performed between January 2008 through March 2019. Outcomes included operative time, estimated blood loss (EBL), blood transfusion, complications, post-hepatectomy liver failure (PHLF), length of stay, 30-day readmission, and 30-day and 90-day mortality. Patients were grouped based on JDS defined as: low (< 4), intermediate (4-6), and high (7 +) complexity procedures. Statistical comparisons were analyzed by ANOVA or χ2 test. RESULTS 241 of 657 patients underwent robotic-assisted resection. Of these patients, 137 were included in the analysis based on JDS: 25 low, 58 intermediate, and 54 high. High JDS was associated with more major resections (≥ 4 contiguous segments) versus minor resections (median JDS 8 vs. 5, P < 0.0001). High JDS was associated with significantly longer operative times, higher EBL, and more blood transfusions. High JDS was associated with higher rates of PHLF at 16.7%, compared with 5.2% intermediate and 0.0% low, (P = 0.018). Complication rates, 30-day readmissions, and mortality rates were similar between groups. Median LOS was longer in patients with high JDS compared with intermediate and low (4 days vs. 3 days vs. 2 days; P = 0.0005). DISCUSSION Higher JDS was associated with multiple indicators of operative complexity, including greater extent of resection, increased operative time, EBL, blood transfusion, PHLF, and LOS. This validation study supports the ability of the JDS to categorize patients undergoing robotic-assisted hepatectomy by complexity.
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Affiliation(s)
- Ansley Beth Ricker
- Division of HPB Surgery, Department of Surgery, Atrium Health - Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 600, Charlotte, NC, 28204, USA.
| | - Joshua M Davis
- Division of HPB Surgery, Department of Surgery, Atrium Health - Carolinas Medical Center, Charlotte, NC, USA
| | - Benjamin M Motz
- Division of HPB Surgery, Department of Surgery, Atrium Health - Carolinas Medical Center, Charlotte, NC, USA
| | - Michael Watson
- Division of HPB Surgery, Department of Surgery, Atrium Health - Carolinas Medical Center, Charlotte, NC, USA
| | - Michael Beckman
- Division of HPB Surgery, Department of Surgery, Atrium Health - Carolinas Medical Center, Charlotte, NC, USA
- Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Michael Driedger
- Division of HPB Surgery, Department of Surgery, Atrium Health - Carolinas Medical Center, Charlotte, NC, USA
- Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - John B Martinie
- Division of HPB Surgery, Department of Surgery, Atrium Health - Carolinas Medical Center, Charlotte, NC, USA
- Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Dionisios Vrochides
- Division of HPB Surgery, Department of Surgery, Atrium Health - Carolinas Medical Center, Charlotte, NC, USA
- Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
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Fontana AP, Russolillo N, Di Menno Stavron J, Langella S, Tesoriere RL, Ricotti A, Ferrero A. Inverse probability of treatment weighting analysis of laparoscopic versus open Sg4b-5 bi-segmentectomy in patients with gallbladder cancer. Updates Surg 2023; 75:1471-1480. [PMID: 37495871 DOI: 10.1007/s13304-023-01599-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/15/2023] [Indexed: 07/28/2023]
Abstract
Sg4b-5 anatomical bi-segmentectomy with regional lymphadenectomy (Sg4b5) is a surgical option for gallbladder cancer (GBC) treatment. The laparoscopic approach to this challenging operation is still controversial. Aim of this study was to compare short- and long-term outcomes of laparoscopic versus open Sg4b5 in a single institution series of patients. All consecutive patients who underwent Sg4b5 for GBC from January 2000 to September 2021 were retrospectively reviewed. Inverse probability of treatment weighting (IPTW) analysis was performed. 75 patients were analyzed, 18 in the laparoscopic and 57 in the open group. After IPTW, laparoscopic approach was associated with a significantly decreased median intraoperative blood loss (100 vs 237.09 ml, p = 0.001), shorter median length of hospital stay (4 vs 8 days, p = < 0.001) and a higher median number of harvested nodes (9 vs 7, p = 0.026). Operation time was shorter in the open group (355 vs 259 min, p < 0.001). No significant differences were found regarding clear resection margins, overall and major (Clavien-Dindo ≥ 3) morbidity, bile leakage rate, 90 days post-operative mortality, overall and disease-free survival. Laparoscopic Sg4b-5 anatomical bi-segmentectomy and regional lymphadenectomy is feasible and safe with long term outcome comparable to open approach at least in early stages. Laparoscopic approach confirms its well-known short-term benefits with less intraoperative bleeding and shorter length of stay. Moreover, it might allow a better lymphadenectomy.
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Affiliation(s)
- Andrea P Fontana
- Department of General and Oncological Surgery, Mauriziano Hospital, Largo Turati 62, 10128, Turin, Italy.
| | - Nadia Russolillo
- Department of General and Oncological Surgery, Mauriziano Hospital, Largo Turati 62, 10128, Turin, Italy
| | - Juliana Di Menno Stavron
- Department of General and Oncological Surgery, Mauriziano Hospital, Largo Turati 62, 10128, Turin, Italy
| | - Serena Langella
- Department of General and Oncological Surgery, Mauriziano Hospital, Largo Turati 62, 10128, Turin, Italy
| | - Roberto Lo Tesoriere
- Department of General and Oncological Surgery, Mauriziano Hospital, Largo Turati 62, 10128, Turin, Italy
| | - Andrea Ricotti
- Clinical Trial Unit, Medical Direction of Hospital, Mauriziano Hospital, Turin, Italy
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, Mauriziano Hospital, Largo Turati 62, 10128, Turin, Italy
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Liu R, Abu Hilal M, Wakabayashi G, Han HS, Palanivelu C, Boggi U, Hackert T, Kim HJ, Wang XY, Hu MG, Choi GH, Panaro F, He J, Efanov M, Yin XY, Croner RS, Fong YM, Zhu JY, Wu Z, Sun CD, Lee JH, Marino MV, Ganpati IS, Zhu P, Wang ZZ, Yang KH, Fan J, Chen XP, Lau WY. International experts consensus guidelines on robotic liver resection in 2023. World J Gastroenterol 2023; 29:4815-4830. [PMID: 37701136 PMCID: PMC10494765 DOI: 10.3748/wjg.v29.i32.4815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/22/2023] [Accepted: 08/09/2023] [Indexed: 08/25/2023] Open
Abstract
The robotic liver resection (RLR) has been increasingly applied in recent years and its benefits shown in some aspects owing to the technical advancement of robotic surgical system, however, controversies still exist. Based on the foundation of the previous consensus statement, this new consensus document aimed to update clinical recommendations and provide guidance to improve the outcomes of RLR clinical practice. The guideline steering group and guideline expert group were formed by 29 international experts of liver surgery and evidence-based medicine (EBM). Relevant literature was reviewed and analyzed by the evidence evaluation group. According to the WHO Handbook for Guideline Development, the Guidance Principles of Development and Amendment of the Guidelines for Clinical Diagnosis and Treatment in China 2022, a total of 14 recommendations were generated. Among them were 8 recommendations formulated by the GRADE method, and the remaining 6 recommendations were formulated based on literature review and experts' opinion due to insufficient EBM results. This international experts consensus guideline offered guidance for the safe and effective clinical practice and the research direction of RLR in future.
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Affiliation(s)
- Rong Liu
- Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100000, China
| | - Mohammed Abu Hilal
- Hepatobiliary Pancreatic, Robotic & Laparoscopic Surgery, Poliambulanza Foundation Hospital, Brescia 25100, Italy
| | - Go Wakabayashi
- Center for Advanced Treatment of HBP Diseases, Ageo Central General Hospital, Saitama 362-0075, Japan
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Chinnusamy Palanivelu
- GEM Hospital & Research Centre, GEM Hospital & Research Centre, Coimbatore 641045, India
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa 56126, Italy
| | - Thilo Hackert
- Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg 20251, Germany
| | - Hong-Jin Kim
- Department of Surgery, Yeungnam University Hospital, Daegu 42415, South Korea
| | - Xiao-Ying Wang
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Ming-Gen Hu
- Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100000, China
| | - Gi Hong Choi
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Severance Hospital, Yonsei University, College of Medicine, Seoul 03722, South Korea
| | - Fabrizio Panaro
- Department of Surgery/Division of Robotic and HBP Surgery, Montpellier University Hospital-School of Medicine, Montpellier 34090, France
| | - Jin He
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21218, United States
| | - Mikhail Efanov
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow 111123, Russia
| | - Xiao-Yu Yin
- Department of Pancreatobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
| | - Roland S Croner
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg 39120, Germany
| | - Yu-Man Fong
- Department of Surgery, City of Hope Medical Center, Duarte, CA 91010, United States
| | - Ji-Ye Zhu
- Department of Hepatobiliary Surgery, Peking University People’s Hospital, Beijing 100000, China
| | - Zheng Wu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Chuan-Dong Sun
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Jae Hoon Lee
- Division of Hepatobiliary & Pancreatic surgery, Asan Medical Center, University of Ulsan College of Medicine, Ulsan 682, South Korea
| | - Marco V Marino
- General Surgery Department, F. Tappeiner Hospital, Merano 39012, Italy
| | - Iyer Shridhar Ganpati
- Hepatobiliary and Pancreatic Surgery, National University Hospital, Singapore 189969, Singapore
| | - Peng Zhu
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
| | - Zi-Zheng Wang
- Department of Hepatobiliary Surgery, Senior Department of Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100000, China
| | - Ke-Hu Yang
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Jia Fan
- Zhongshan Hospital, Fudan University, Shanghai 200000, China
| | - Xiao-Ping Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
| | - Wan Yee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
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Mahamid A, Abu-Zaydeh O, Mattar S, Kazlow E, Froylich D, Sawaied M, Goldberg N, Berger Y, Sadot E, Haddad R. Short- and Long-Term Outcomes in Elderly Patients Following Hand-Assisted Laparoscopic Surgery for Colorectal Liver Metastasis. J Clin Med 2023; 12:4785. [PMID: 37510900 PMCID: PMC10381412 DOI: 10.3390/jcm12144785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/06/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Hand-assisted laparoscopic surgery (HALS) has engendered growing attention as a safe procedure for the resection of metastatic liver disease. However, there is little data available regarding the outcomes of HALS for colorectal liver metastasis (CRLM) in patients over the age of 75. (2) Methods: We compare the short- and long-term outcomes of patients >75-years-old (defined in our study as "elderly patients" and referred to as group 1, G1), with patients <75-years-old (defined in our study as "younger patients" and referred to as group 2, G2). (3) Results: Of 145 patients, 28 were in G1 and 117 were in G2. The most common site of the primary tumor was the right colon in G1, and the left colon in G2 (p = 0.05). More patients in G1 underwent laparoscopic anterior segment resection compared with G2 (43% vs. 39% respectively) (p = 0.003). 53% of patients in G1 and 74% of patients in G2 completed neoadjuvant therapy (p = 0.04). The median size of the largest metastasis was 32 (IQR 19-52) mm in G1 and 20 (IQR 13-35) mm in G2 (p = 0.001). The rate of complications (Dindo-Clavien grade ≥ III) was slightly higher in G1 (p = 0.06). The overall 5-year survival was 30% in G1 and 52% in G2 (p = 0.12). (4) Conclusions: Hand-assisted laparoscopic surgery for colorectal liver metastasis is safe and effective in an elderly patient population.
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Affiliation(s)
- Ahmad Mahamid
- Department of Surgery, Carmel Medical Center, Haifa 3436212, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Omar Abu-Zaydeh
- Department of Surgery, Carmel Medical Center, Haifa 3436212, Israel
| | - Samar Mattar
- Department of Surgery, Carmel Medical Center, Haifa 3436212, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Esther Kazlow
- Department of Surgery, Carmel Medical Center, Haifa 3436212, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Dvir Froylich
- Department of Surgery, Carmel Medical Center, Haifa 3436212, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Muneer Sawaied
- Department of Surgery, Carmel Medical Center, Haifa 3436212, Israel
| | - Natalia Goldberg
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
- Department of Radiology, Carmel Medical Center, Haifa 3436212, Israel
| | - Yael Berger
- Department of Surgery, Rabin Medical Center, Petch Tikvah 4941492, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Eran Sadot
- Department of Surgery, Rabin Medical Center, Petch Tikvah 4941492, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Riad Haddad
- Department of Surgery, Carmel Medical Center, Haifa 3436212, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
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Ng KKC. Minimally Invasive Hepatectomy for Liver Tumors: Where Are We Now? J Clin Med 2023; 12:4583. [PMID: 37510698 PMCID: PMC10380258 DOI: 10.3390/jcm12144583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
With advancements in minimally invasive (MIS) technology and techniques, MIS hepatectomy has evolved as an effective treatment for both benign and malignant liver tumors [...].
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Affiliation(s)
- Kelvin K C Ng
- Department of Surgery, The Chinese University of Hong Kong, New Territories 852, Hong Kong
- Department of Surgery, Prince of Wales Hospital, New Territories 852, Hong Kong
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47
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Morise Z. Editorial (Preface) for the Special Issue on Advances in Minimally Invasive Liver Resection for Cancer Therapies. Cancers (Basel) 2023; 15:3520. [PMID: 37444631 DOI: 10.3390/cancers15133520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
After the initial reports of laparoscopic liver resection (LLR) in the early 1990s, minimally invasive liver resection has been rapidly developing based on technical and instrumental improvements [...].
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Affiliation(s)
- Zenichi Morise
- Department of Surgery, School of Medicine, Fujita Health University Okazaki Medical Center, 1 Gotanda Harisakicho, Okazaki 444-0827, Aichi, Japan
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Alvaro D, Gores GJ, Walicki J, Hassan C, Sapisochin G, Komuta M, Forner A, Valle JW, Laghi A, Ilyas SI, Park JW, Kelley RK, Reig M, Sangro B. EASL-ILCA Clinical Practice Guidelines on the management of intrahepatic cholangiocarcinoma. J Hepatol 2023; 79:181-208. [PMID: 37084797 DOI: 10.1016/j.jhep.2023.03.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 04/23/2023]
Abstract
Intrahepatic cholangiocarcinoma (iCCA) develops inside the liver, between bile ductules and the second-order bile ducts. It is the second most frequent primary liver cancer after hepatocellular carcinoma, and its global incidence is increasing. It is associated with an alarming mortality rate owing to its silent presentation (often leading to late diagnosis), highly aggressive nature and resistance to treatment. Early diagnosis, molecular characterisation, accurate staging and personalised multidisciplinary treatments represent current challenges for researchers and physicians. Unfortunately, these challenges are beset by the high heterogeneity of iCCA at the clinical, genomic, epigenetic and molecular levels, very often precluding successful management. Nonetheless, in the last few years, progress has been made in molecular characterisation, surgical management, and targeted therapy. Recent advances together with the awareness that iCCA represents a distinct entity amongst the CCA family, led the ILCA and EASL governing boards to commission international experts to draft dedicated evidence-based guidelines for physicians involved in the diagnostic, prognostic, and therapeutic management of iCCA.
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Chen YC, Lee MH, Hsueh SN, Liu CL, Hui CK, Soong RS. The influence of the Pringle maneuver in laparoscopic hepatectomy: continuous monitor of hemodynamic change can predict the perioperatively physiological reservation. Front Big Data 2023; 6:1042516. [PMID: 37388503 PMCID: PMC10303928 DOI: 10.3389/fdata.2023.1042516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 05/23/2023] [Indexed: 07/01/2023] Open
Abstract
Importance This is the first study to investigate the correlation between intra-operative hemodynamic changes and postoperative physiological status. Objective Design settings and participants Patients receiving laparoscopic hepatectomy were routinely monitored using FloTract for goal-directed fluid management. The Pringle maneuver was routinely performed during parenchymal dissection and the hemodynamic changes were prospectively recorded. We retrospectively analyzed the continuous hemodynamic data from FloTrac to compare with postoperative physiological outcomes. Exposure The Pringle maneuver during laparoscopic hepatectomy. Main outcomes and measures Results Stroke volume variation that did not recover from the relief of the Pringle maneuver during the last application of Pringle maneuver predicted elevated postoperative MELD-Na scores. Conclusions and relevance The complexity of the hemodynamic data recorded by the FloTrac system during the Pringle Maneuver in laparoscopic hepatectomy can be effectively analyzed using the growth mixture modeling (GMM) method. The results can potentially predict the risk of short-term liver function deterioration.
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Affiliation(s)
- Yi-Chan Chen
- Department of General Surgery, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Min-Hsuan Lee
- Department of Industrial Engineering and Management, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Shan-Ni Hsueh
- Department of Industrial Engineering and Management, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Chien-Liang Liu
- Department of Industrial Engineering and Management, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Chung-Kun Hui
- Department of Anestheiology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ruey-Shyang Soong
- Division of Transplantation, Department of Surgery, Taipei Municipal Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
- College of Medicine, Taipei, Medical University, Taipei, Taiwan
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Lin ZY, Zhang XP, Zhao GD, Li CG, Wang ZH, Liu R, Hu MG. Short-term outcomes of robotic versus open hepatectomy among overweight patients with hepatocellular carcinoma: a propensity score-matched study. BMC Surg 2023; 23:153. [PMID: 37286991 DOI: 10.1186/s12893-023-02058-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/26/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Robotic hepatectomy (RH) has gradually been accepted as it has overcome some of the limitations of open hepatectomy (OH). This study was to compare short-term outcomes in RH and OH for overweight (preoperative body mass index ≥ 25 kg/m²) patients with hepatocellular carcinoma (HCC). METHODS Perioperative and postoperative data from these patients who underwent RH or OH between January 2010 and December 2020 were retrospectively analyzed. Propensity score matching (PSM) analysis was performed to determine the impact of RH versus OH on the prognosis of overweight HCC patients. RESULTS All 304 overweight HCC patients were included, 172 who were underwent RH, and 132 who were underwent OH. After the 1:1 PSM, there were 104 patients in both RH and OH groups. After PSM, the RH group of patients had a shorter operative time, less estimated blood loss (EBL), a longer total clamping time, a shorter postoperative length of stay (LOS), less chance of surgical site infection and less rates of blood transfusion (all P < 0.05) compared to the OH patients. The differences between operative time, EBL and LOS were more significant in obese patients. RH was found to be an independent protective factor of EBL ≥ 400ml relative to OH in overweight patients for the first time. CONCLUSIONS RH was safe and feasible in overweight HCC patients. Compared with OH, RH has advantages in terms of operative time, EBL, postoperative LOS, and surgical site infection. Carefully selected overweight patients should be considered for RH.
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Affiliation(s)
- Zhao-Yi Lin
- Medical School of Chinese PLA, Beijing, 100853, China
- Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Xiu-Ping Zhang
- Medical School of Chinese PLA, Beijing, 100853, China
- Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Guo-Dong Zhao
- Medical School of Chinese PLA, Beijing, 100853, China
- Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Cheng-Gang Li
- Medical School of Chinese PLA, Beijing, 100853, China
- Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Zhao-Hai Wang
- Medical School of Chinese PLA, Beijing, 100853, China
- Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Rong Liu
- Medical School of Chinese PLA, Beijing, 100853, China.
- Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
| | - Ming-Gen Hu
- Medical School of Chinese PLA, Beijing, 100853, China.
- Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
- Department of Hepatobiliary, Pancreatic Surgical Oncology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
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