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Parrales-Mora M, Cremades M, Parés D, García RD, Pardo Aranda F, Zárate Pinedo A, Navinés López J, Espin Alvarez F, Julian-Ibanez JF, Cugat Andorra E. Morbidity and mortality of elderly patients with pancreaticobiliary disease according to age and comprehensive geriatric assessment: A prospective observational study. Gastroenterol Hepatol 2024; 47:439-447. [PMID: 37741326 DOI: 10.1016/j.gastrohep.2023.09.004] [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] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/11/2023] [Accepted: 09/15/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND This study was designed to analyze the influence of age and comprehensive geriatric evaluation on clinical results of pancreaticobiliary disease management in elderly patients. METHODS A prospective observational study has been undertaken, including 140 elderly patients (over 75 years) with benign pancreaticobiliary disease. Patients were divided according to age in the following groups: group 1: 75-79 years old; group 2: 80-84 years old; group 3: 85 years and older. They underwent a comprehensive geriatric assessment with different scales: Barthel Index, Pfeiffer Index, Charlson Index, and Fragility scale, at admission and had been follow-up 90 days after hospital discharge to analyze its influence on morbidity and mortality. RESULTS Overall, 140 patients have been included (group 1=51; group 2=43 and group 3=46). Most of them, 52 cases (37.8%), had acute cholecystitis, followed by 29 cases of acute cholangitis (20.2%) and acute pancreatitis with 25 cases (17.9%). Significant differences has been observed on complications in different age groups (p=0.033). Especially in patients with a Barthel Index result ≤60, which suggests that these less functional patients had more severe complications after their treatment (p=0.037). The mortality rate was 7.1% (10 patients). CONCLUSIONS No significant differences were found between age, morbidity and mortality in elderly patients with pancreaticobiliary disease. Comprehensive geriatric scales showed some utility in their association with specific complications.
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Affiliation(s)
- Mauricio Parrales-Mora
- Hepatobiliary and Pancreas Unit, Department of General and Digestive Surgery, Spain; Department of General and Digestive Surgery, School of Medicine, Universitat Autònoma de Barcelona, Spain
| | - Manel Cremades
- Hepatobiliary and Pancreas Unit, Department of General and Digestive Surgery, Spain; Department of General and Digestive Surgery, School of Medicine, Universitat Autònoma de Barcelona, Spain
| | - David Parés
- Department of General and Digestive Surgery, School of Medicine, Universitat Autònoma de Barcelona, Spain.
| | - Rebeca D García
- Department of General and Digestive Surgery, School of Medicine, Universitat Autònoma de Barcelona, Spain
| | - Fernando Pardo Aranda
- Department of General and Digestive Surgery, School of Medicine, Universitat Autònoma de Barcelona, Spain
| | - Alba Zárate Pinedo
- Hepatobiliary and Pancreas Unit, Department of General and Digestive Surgery, Spain; Department of General and Digestive Surgery, School of Medicine, Universitat Autònoma de Barcelona, Spain
| | - Jordi Navinés López
- Hepatobiliary and Pancreas Unit, Department of General and Digestive Surgery, Spain
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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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Sentí Farrarons S, Pardo Aranda F, Galofré Recasens M, Espin Álvarez F, Herrero Fonollosa E, García Domingo MI, Cremades Pérez M, Zárate Pinedo A, Camps Lassa J, Navinés López J, Cugat Andorra E. Venous resection in pancreatic oncologic surgery: Different techniques for different situations. Cir Esp 2023; 101:816-823. [PMID: 36706805 DOI: 10.1016/j.cireng.2023.01.001] [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: 02/23/2022] [Revised: 08/03/2022] [Accepted: 10/30/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION To report the clinical results of patients with malignant pancreatic lesions who underwent oncological surgery with vascular resection. The type of intervention performed, types of vascular reconstruction, the pathological anatomy results, postoperative morbidity and mortality, and survival at 3 and 5 years were analyzed. METHODS Retrospective, cross-sectional and comparative analysis. We include 41 patients with malignant pancreatic lesions who underwent surgery with vascular resection due to vascular involvement, from 2013 to 2021. RESULTS The most performed surgery was pancreaticoduodenectomy (Whipple procedure) using median laparotomy, in 35 out of the 41 patients (85%). One of the cases in the series was performed laparoscopically. Type 1 reconstruction (simple suture) was performed in 11 (27%) patients, type 2 in 4 (10%) cases, type 3 (end-to-end) in 23 (56%) cases, and type 4 reconstruction by autologous graft in 3 (7%) cases. The mean length of the resected venous segment was 21 (11-46) mm, and mean surgical time was 290 (220-360) minutes. 90% (37/41) were pancreatic adenocarcinoma. 83% were considered R0, and there was involvement in the resected vascular section in 41% of the cases. Four patients had Clavien Dindo morbidity >3, and there were no cases of postoperative mortality. Survival at 3 years was 48% and at 5 years 20%. CONCLUSIONS The aggressive surgical treatment with venous resection in pancreatic malignant lesions to ensure R0 and its vascular reconstruction is a feasible technique, with an acceptable morbid-mortality rate and overall survival.
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Affiliation(s)
- Sara Sentí Farrarons
- Departamento de Cirugía General, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Fernando Pardo Aranda
- Unidad HPB, Departamento de Cirugía General, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain.
| | - Maria Galofré Recasens
- Departamento de Cirugía General, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Barcelona, Spain
| | - Francesc Espin Álvarez
- Unidad HPB, Departamento de Cirugía General, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Eric Herrero Fonollosa
- Unidad HPB, Departamento de Cirugía General, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Barcelona, Spain
| | - Maria Isabel García Domingo
- Unidad HPB, Departamento de Cirugía General, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Barcelona, Spain
| | - Manel Cremades Pérez
- Unidad HPB, Departamento de Cirugía General, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Alba Zárate Pinedo
- Unidad HPB, Departamento de Cirugía General, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Judith Camps Lassa
- Unidad HPB, Departamento de Cirugía General, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Barcelona, Spain
| | - Jordi Navinés López
- Unidad HPB, Departamento de Cirugía General, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Esteban Cugat Andorra
- Jefe Clínico de la Unidad HPB, Departamento de Cirugía General, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Jefe Clínico de la Unidad HPB, Departamento de Cirugía General, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
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Espin Alvarez F, García-Domingo MI, Cremades Pérez M, Pardo Aranda F, Vidal Piñeiro L, Herrero Fonollosa E, Navinés López J, Zárate Pinedo A, Camps-Lasa J, Cugat Andorrà E. Laparoscopic and robotic distal pancreatectomy: the choice and the future. Cir Esp 2023; 101:765-771. [PMID: 37119949 DOI: 10.1016/j.cireng.2023.04.017] [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: 09/29/2022] [Revised: 01/03/2023] [Accepted: 02/21/2023] [Indexed: 05/01/2023]
Abstract
INTRODUCTION Distal pancreatectomy (DP) is currently well established as a minimally invasive surgery (MIS) procedure, using either a laparoscopic (LDP) or robotic (RDP) approach. METHODS Out of 83 DP performed between January 2018 and March 2022, 57 cases (68.7%) were performed using MIS: 35 LDP and 22 RDP (da Vinci Xi). We have assessed the experience with the two techniques and analyzed the value of the robotic approach. Cases of conversion have been examined in detail. RESULTS The mean operative times for LDP and RDP were 201.2 (SD 47.8) and 247.54 (SD 35.8) minutes, respectively (P = NS). No differences were observed in length of hospital stay or conversion rate: 6 (5-34) vs. 5.6 (5-22) days, and 4 (11.4%) vs. 3 (13.6%) cases, respectively (P = NS). The readmission rate was 3/35 patients (11.4%) treated with LDP and 6/22 (27.3%) cases of RDP (P = NS). There were no differences in morbidity (Dindo-Clavien ≥ III) between the two groups. Mortality was one case in the robotic group (a patient with early conversion due to vascular involvement). The rate of R0 resection was greater and statistically significant in the RDP group (77.1% vs. 90.9%) (P = .04). CONCLUSION Minimally invasive distal pancreatectomy (MIDP) is a safe and feasible procedure in selected patients. Surgical planning and stepwise implementation based on prior experience help surgeons successfully perform technically demanding procedures. RDP could be the approach of choice in distal pancreatectomy, and it is not inferior to LDP.
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Affiliation(s)
- Francisco Espin Alvarez
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain.
| | - María Isabel García-Domingo
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Spain
| | - Manel Cremades Pérez
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Fernando Pardo Aranda
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Laura Vidal Piñeiro
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Eric Herrero Fonollosa
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Spain
| | - Jordi Navinés López
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Alba Zárate Pinedo
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Judith Camps-Lasa
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Spain
| | - Esteban Cugat Andorrà
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain; Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Spain
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Galofré-Recasens M, Espin Álvarez F, Pardo Aranda F, Cugat Andorrà E. Robotic distal pancreatectomy with splenic preservation. Cir Esp 2023; 101:787. [PMID: 37088363 DOI: 10.1016/j.cireng.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Affiliation(s)
- María Galofré-Recasens
- Unidad de Cirugía Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
| | - Francisco Espin Álvarez
- Unidad de Cirugía Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Fernando Pardo Aranda
- Unidad de Cirugía Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Esteban Cugat Andorrà
- Unidad de Cirugía Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Unidad de Cirugía Hepatobiliopancreática, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, Spain
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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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Herrero Fonollosa E, Galofré Recasens M, Zárate Pinedo A, García Domingo MI, Camps Lasa J, Pardo Aranda F, Espin Álvarez F, Cugat Andorrà E. Long-term results of liver-first approach strategy in patients with advanced synchronous liver metastases from colorectal cancer. Cir Esp 2023; 101:341-349. [PMID: 35667607 DOI: 10.1016/j.cireng.2022.06.011] [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: 11/25/2021] [Accepted: 04/15/2022] [Indexed: 05/16/2023]
Abstract
BACKGROUND The "liver-first" approach (LFA) is a strategy indicated for advanced synchronous liver metastases (ASLM) from colorectal cancer (CRC). Includes neoadjuvant chemotherapy, resection of the ASLM followed by CRC resection. METHODS Retrospective descriptive analysis from a prospective database of hepatectomies from liver metastases (LM) from CRC in two centers. Between 2007-2019, 88 patients with CRC-ASLM were included in a LFA scheme. Bilobar (LM) was present in 65.9%, the mean number of lesions was 5.5 and mean size 42.7 mm. Response to treatment was assessed by RECIST criteria. Progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan-Meier survival curves. RESULTS Seventy-five of 88 patients (85.2%) completed the LFA. RECIST evaluation showed partial response in 75.7% and stable disease in 22.8%. Severe morbidity rate (Clavien-Dindo ≥ IIIA) after liver and colorectal surgery was present in 29.4% and 9.3%, respectively. There was no 90-day postoperative mortality in both liver and colorectal surgeries. Recurrence rate was 76%, being the liver the most frequent site, followed by the pulmonary. From the total number of recurrences (106) in 56 patients, surgical with chemotherapy rescue treatment was accomplished in 34 of them (32.1%). The mean PFS was 8.5 and 5-year OS was 53%. CONCLUSIONS In patients with CRC-ASLM the LFA allows control of the liver disease beforehand and an assessment of the tumor response to neoadjuvant chemotherapy, optimising the chance of potentially curative liver resection, which influences long-term survival.
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Affiliation(s)
- Eric Herrero Fonollosa
- Unidad de Cirugía HBP, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, Spain.
| | - María Galofré Recasens
- Unidad de Cirugía HBP, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, Spain
| | - Alba Zárate Pinedo
- Unidad de Cirugía HBP, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Maria Isabel García Domingo
- Unidad de Cirugía HBP, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, Spain
| | - Judith Camps Lasa
- Unidad de Cirugía HBP, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, Spain
| | - Fernando Pardo Aranda
- Unidad de Cirugía HBP, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Francisco Espin Álvarez
- Unidad de Cirugía HBP, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Esteban Cugat Andorrà
- Unidad de Cirugía HBP, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, Spain; Unidad de Cirugía HBP, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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López-Sánchez J, Garrosa-Muñoz S, Pardo Aranda F, Gené Škrabec C, López Pérez R, Rodríguez-Fortúnez P, Sánchez Santos JM, Muñoz-Bellvís L. Dose and administration time of indocyanine green in near-infrared fluorescence cholangiography during laparoscopic cholecystectomy (DOTIG): study protocol for a randomised clinical trial. BMJ Open 2023; 13:e067794. [PMID: 36868593 PMCID: PMC9990661 DOI: 10.1136/bmjopen-2022-067794] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND One of the most severe complications in laparoscopic cholecystectomy (LC) is intraoperative bile duct injury (BDI). Despite its low incidence, the medical implications for the patient can be serious. Besides, BDI can also generate significant legal issues in healthcare. Different techniques have been described to reduce the incidence of this complication, and near-infrared fluorescence cholangiography with indocyanine green (NIRFC-ICG) is one of the latest additions. In spite of the great interest aroused by this procedure, there are currently great disparities in the usage or administration protocols of ICG. METHODS AND ANALYSIS This is a randomised, multicentre, per-protocol analysis, open clinical trial with four arms. The estimated duration of the trial is 12 months. The aim of the study is to analyse whether there are differences between the dose and administration ICG intervals to obtain good-quality NIRFC during LC. The primary outcome is the degree of identification of critical biliary structures during LC. In addition, different factors will be analysed that may have an influence on the results of this technique. ETHICS AND DISSEMINATION The trial will be conducted according to the recommendations for Clinical Trials in the Declaration of Helsinki Ethical Principles for Medical Research Involving Human Subjects and the recommendations of the Spanish Agency of Medicines and Medical Devices (AEMPs) for clinical trials. This trial was approved by the local institutional Ethics Committee and the AEMPs. The results of the study will be presented to the scientific community through publications, conferences or other means. EUDRACT NUMBER 2022-000904-36. PROTOCOL VERSION V.1.4, 2 June 2022 TRIAL REGISTRATION NUMBER: NCT05419947.
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Affiliation(s)
- Jaime López-Sánchez
- Department of General and Gastrointestinal Surgery, Hospital Universitario de Salamanca, Salamanca, Spain
- Biomedical Research Institute of Salamanca (IBSAL), Universidad de Salamanca, Salamanca, Spain
| | - Sonsoles Garrosa-Muñoz
- Department of General and Gastrointestinal Surgery, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Fernando Pardo Aranda
- Department of General and Gastrointestinal Surgery, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Clara Gené Škrabec
- Department of General and Gastrointestinal Surgery, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Ricardo López Pérez
- UICEC-Biomedical Research Institute of Salamanca (IBSAL), Universidad de Salamanca, Salamanca, Spain
| | | | | | - Luis Muñoz-Bellvís
- Department of General and Gastrointestinal Surgery, Hospital Universitario de Salamanca, Salamanca, Spain
- Biomedical Research Institute of Salamanca (IBSAL), Universidad de Salamanca, Salamanca, Spain
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Cugat E, Pardo Aranda F. Cirugía robótica hepatobiliopancreática: una oportunidad real con vocación de futuro. Cir Esp 2023. [DOI: 10.1016/j.ciresp.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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Cugat E, Aranda FP. Robotic HBP surgery: a real opportunity with future potential. Cir Esp 2023:S2173-5077(23)00040-6. [PMID: 36781047 DOI: 10.1016/j.cireng.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/17/2022] [Indexed: 02/13/2023]
Affiliation(s)
- Esteban Cugat
- Hospital Universitario Germans Trias i Pujol - Hospital Universitario Mutua Terrassa.
| | - Fernando Pardo Aranda
- Unidad Hepatobiliopancreática. Cirugía General y Digestiva, Hospital Universitario Germans Trias i Pujol, Barcelona, Spain.
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Pardo Aranda F, Gené Škrabec C, López-Sánchez J, Zarate Pinedo A, Espin Álvarez F, Cremades Pérez M, Navinés López J, Herrero Vicente C, Vidal Piñeiro L, Cugat Andorrà E. Indocyanine green (ICG) fluorescent cholangiography in laparoscopic cholecystectomy: Simplifying time and dose. Dig Liver Dis 2023; 55:249-253. [PMID: 36404235 DOI: 10.1016/j.dld.2022.10.023] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/15/2022] [Accepted: 10/23/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND This article aims to analyze and to simplify the optimal dose and time of intravenous indocyanine green (ICG) administration to achieve the identification of the cystic duct and the common bile duct (CBD). METHODS A consecutive series of 146 patients was prospectively analyzed and divided into three groups according to the time of ICG administration: at induction of anesthesia group (20-30 min); hours before group (between 2 and 6 h); and the day before group (≥6 h); and two groups according to the dose of ICG: 1 cc (2.5 mg) or weight-based dose (0.05 mg/kg). RESULTS The CBD was better visualized in the at induction of anesthesia group (85.4%), in the hours before group (97.1%) (p = 0.002) and in the 1cc group (p = 0.011). When we analyzed the 1 cc group (n = 126) a greater visualization of the CBD was observed in the at induction of anesthesia group (86.7%) and in the hours before group (97.1%) (p = 0.027). CONCLUSION Due to its simplicity and reproducibility, we suggest a dose of 2.5 mg administered 2-6 h before the procedure is the optimal. However, ICG administered 30 min prior to the surgery is enough for adequate visualization of biliary structures.
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Affiliation(s)
- Fernando Pardo Aranda
- Department of General and Digestive Surgery, HPB Unit, Hospital Germans Trias i Pujol, Ctra. del Canyet s/n, Badalona, Barcelona 08916, Spain
| | - Clara Gené Škrabec
- Department of General and Digestive Surgery, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.
| | - Jaime López-Sánchez
- Department of General and Digestive Surgery, Hospital Universitario de Salamanca, Spain
| | - Alba Zarate Pinedo
- Department of General and Digestive Surgery, HPB Unit, Hospital Germans Trias i Pujol, Ctra. del Canyet s/n, Badalona, Barcelona 08916, Spain
| | - Francisco Espin Álvarez
- Department of General and Digestive Surgery, HPB Unit, Hospital Germans Trias i Pujol, Ctra. del Canyet s/n, Badalona, Barcelona 08916, Spain
| | - Manel Cremades Pérez
- Department of General and Digestive Surgery, HPB Unit, Hospital Germans Trias i Pujol, Ctra. del Canyet s/n, Badalona, Barcelona 08916, Spain
| | - Jordi Navinés López
- Department of General and Digestive Surgery, HPB Unit, Hospital Germans Trias i Pujol, Ctra. del Canyet s/n, Badalona, Barcelona 08916, Spain
| | - Christian Herrero Vicente
- Department of General and Digestive Surgery, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Laura Vidal Piñeiro
- Department of General and Digestive Surgery, HPB Unit, Hospital Germans Trias i Pujol, Ctra. del Canyet s/n, Badalona, Barcelona 08916, Spain
| | - Esteban Cugat Andorrà
- Department of General and Digestive Surgery, HPB Unit, Hospital Germans Trias i Pujol, Ctra. del Canyet s/n, Badalona, Barcelona 08916, Spain; Department of General and Digestive Surgery, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
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12
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Herrero Fonollosa E, Galofré Recasens M, Zárate Pinedo A, García Domingo MI, Camps Lasa J, Pardo Aranda F, Espin Álvarez F, Cugat Andorrà E. Análisis retrospectivo de los resultados a largo plazo de la estrategia inversa en pacientes con cáncer colorrectal y enfermedad hepática metastásica sincrónica avanzada. Cir Esp 2022. [DOI: 10.1016/j.ciresp.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Cugat Andorrà E, Cremades Perez M, Navinés López J, Matallana Azorín C, Zárate Pinedo A, Pardo Aranda F, Sendra Gonzalez M, Espin Álvarez F. Challenge and future of liver and pancreatic robotic surgery. Analysis of 64 cases in a specialized unit. Cir Esp 2022; 100:154-160. [PMID: 35221241 DOI: 10.1016/j.cireng.2022.02.012] [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: 11/20/2020] [Accepted: 01/17/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Robotic surgery has proven effective in certain surgical procedures. However, in liver and pancreatic surgery (HBP) its use is still rare. The initial experience in HBP robotic surgery of a specialized unit of a tertiary hospital is presented. METHOD The results of patients undergoing robotic HBP surgery between April 2018 and October 2020 have been prospectively studied. The data analyzed correspond to demographic data, surgical techniques performed, associated morbidity and mortality. RESULTS 64 patients were operated, corresponding to 35 hepatectomies (major [6.7%], anatomic [52.9%], limited [34.4%], cystectomies [3%] and marsupialization [3%]), 29 pancreatectomies (distal [48.2%], central [6.9%], cephalic [13.8%], enucleations [24.1%], ampullectomies [3.5%] and duodenal resections [3.5%]). In liver surgery the mean operative time was 204.4 min (100-265 min), the median postoperative complications according to the Clavien-Dindo scale was one (1-4), the mean blood losses 166.7 mL (100-300 mL), there was no conversion and the mean postoperative stay was four days (2-14 days). In pancreatic surgery, the mean operative time was 243.8 min (125-460 min), the median of postoperative complications was two (1-4), blood loss of 202.3 mL (100-500 mL) associated to a conversion rate 17.8% and an average stay of seven days (3-23 days). CONCLUSIONS Robotic HBP surgery is safe and feasible. It is suggested that its use facilitates parenchymal sparing surgery, access to posterior liver segments and anastomosis in pancreatic reconstruction compared to laparoscopic surgery.
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Di Martino M, Mora-Guzmán I, Jodra VV, Dehesa AS, García DM, Ruiz RC, Nisa FGM, Moreno FM, Batanero SA, Sampedro JEQ, Cumplido PL, Bravo AA, Rubio-Perez I, Asensio-Gomez L, Aranda FP, Farrarons SS, Moreno CR, Moreno CMM, Lasarte AS, Calvo MP, Aparicio-Sánchez D, Del Pozo EP, Pellino G, Martin-Perez E. How to Predict Postoperative Complications After Early Laparoscopic Cholecystectomy for Acute Cholecystitis: the Chole-Risk Score. J Gastrointest Surg 2021; 25:2814-2822. [PMID: 33629230 DOI: 10.1007/s11605-021-04956-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/05/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Early laparoscopic cholecystectomy (ELC) is the gold standard treatment for patients with acute calculous cholecystitis (ACC); however, it is still related to significant postoperative complications. The aim of this study is to identify factors associated with an increased risk of postoperative complications and develop a preoperative score able to predict them. METHODS Multicentric retrospective analysis of 1868 patients with ACC submitted to ELC. Included patients were divided into two groups according to the presentation of increased postoperative complications defined as postoperative complications ≥ Clavien-Dindo IIIa, length of stay greater than 10 days and readmissions within 30 days of discharge. Variables that were independently predictive of increased postoperative complications were combined determining the Chole-Risk Score, which was validated through a correlation analysis. RESULTS We included 282 (15.1%) patients with postoperative complications. The multivariate analysis predictors of increased morbidity were previous percutaneous cholecystostomy (OR 2.95, p=0.001), previous abdominal surgery (OR 1.57, p=0.031) and diabetes (OR 1.62, p=0.005); Charlson Comorbidity Index >6 (OR 2.48, p=0.003), increased total bilirubin > 2 mg/dL (OR 1.88, p=0.002), dilated bile duct (OR 1.79, p=0.027), perforated gallbladder (OR 2.62, p<0.001) and severity grade (OR 1.93, p=0.001). The Chole-Risk Score was generated by grouping these variables into four categories, with scores ranging from 0 to 4. It presented a progressive increase in postoperative complications ranging from 5.8% of patients scoring 0 to 47.8% of patients scoring 4 (p<0.001). CONCLUSION The Chole-Risk Score represents an intuitive tool capable of predicting postoperative complications in patients with ACC.
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Affiliation(s)
- Marcello Di Martino
- HPB Unit, Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Diego de León Street, 62 - 4th Floor, 28006, Madrid, Spain.
| | - Ismael Mora-Guzmán
- HPB Unit, Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Diego de León Street, 62 - 4th Floor, 28006, Madrid, Spain
- Hospital General La Mancha Centro, Alcázar de San Juan, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
- Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Elena Martin-Perez
- HPB Unit, Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Diego de León Street, 62 - 4th Floor, 28006, Madrid, Spain
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15
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Espin Alvarez F, García Domingo MI, Cremades Pérez M, Herrero Fonollosa E, Navinés López J, Camps Lasa J, Pardo Aranda F, Cugat Andorrá E. Highs and lows in laparoscopic pancreaticoduodenectomy. Cir Esp 2021; 99:593-601. [PMID: 34420909 DOI: 10.1016/j.cireng.2021.08.001] [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: 05/12/2020] [Accepted: 07/13/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Laparoscopic pancreaticoduodenectomy (PD) is not widely accepted, and its use is controversial. Only correct patient selection and appropriate training of groups experienced in pancreatic surgery and laparoscopy will be able to establish its role and its hypothetical advantages. METHODS Out of 138 pancreatic surgeries performed in a two-year period (2017-2019), 23 were laparoscopic PD. We evaluate its efficacy and safety compared to 31 open PD. RESULTS There were no cases of B/C pancreatic or biliary fistula, nor any cases of delayed gastric emptying in the laparoscopic group, but hemorrhage required one reoperation. The conversion rate was 21% (five cases): one due to bleeding, and the remainder for non-progression. The converted patients showed no differences compared to those completed by laparoscopy. There were no differences between laparoscopic and open PD in surgical time, postoperative complications, reintervention rate, readmissions or mortality. R0 resection in tumor cases was 85% for laparoscopy and 69% in open surgery without statistical significance. The postoperative hospital stay was shorter in the laparoscopic PD group (eight vs. 15 days). CONCLUSIONS In a selected group, laparoscopic PD can be safely and effectively performed if carried out by groups who are experts in pancreatic surgery and advanced laparoscopy. The technique has the same postoperative results as open surgery and is oncologically adequate, with less hospital stay. Proper patient selection, a step-by-step program and a lax and early conversion prevents serious operating accidents.
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Affiliation(s)
- Francisco Espin Alvarez
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - María Isabel García Domingo
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Spain
| | - Manel Cremades Pérez
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain.
| | - Eric Herrero Fonollosa
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Spain
| | - Jordi Navinés López
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Judith Camps Lasa
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Spain
| | - Fernando Pardo Aranda
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Esteban Cugat Andorrá
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain; Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Spain
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Pardo Aranda F, Cugat Andorrà E, Cremades Pérez M, Zárate Pinedo A. Pancreas anastomosis after laparoscopic and robotic pancreatoduodenectomy. Cir Esp 2021; 99:540. [PMID: 34210651 DOI: 10.1016/j.cireng.2020.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/26/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Fernando Pardo Aranda
- Unidad Hepatobiliopancreática, Cirugía General y Digestiva, Hospital Universitario Germans Trias i Pujol, Barcelona, Spain.
| | - Esteban Cugat Andorrà
- Unidad Hepatobiliopancreática, Cirugía General y Digestiva, Hospital Universitario Germans Trias i Pujol, Barcelona, Spain
| | - Manel Cremades Pérez
- Unidad Hepatobiliopancreática, Cirugía General y Digestiva, Hospital Universitario Germans Trias i Pujol, Barcelona, Spain
| | - Alba Zárate Pinedo
- Unidad Hepatobiliopancreática, Cirugía General y Digestiva, Hospital Universitario Germans Trias i Pujol, Barcelona, Spain
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17
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Cugat Andorrà E, Cremades Perez M, Navinés López J, Matallana Azorín C, Zárate Pinedo A, Pardo Aranda F, Sendra Gonzalez M, Espin Álvarez F. Challenge and future of liver and pancreatic robotic surgery. Analysis of 64 cases in a specialized unit. Cir Esp 2021; 100:S0009-739X(21)00031-2. [PMID: 33714554 DOI: 10.1016/j.ciresp.2021.01.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/20/2020] [Accepted: 01/17/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Robotic surgery has proven effective in certain surgical procedures. However, in liver and pancreatic surgery (HBP) its use is still rare. The initial experience in HBP robotic surgery of a specialized unit of a tertiary hospital is presented. METHOD The results of patients undergoing robotic HBP surgery between April 2018 and October 2020 have been prospectively studied. The data analyzed correspond to demographic data, surgical techniques performed, associated morbidity and mortality. RESULTS 64 patients were operated, corresponding to 35 hepatectomies (major [6.7%], anatomic [52.9%], limited [34.4%], cystectomies [3%] and marsupialization [3%]), 29 pancreatectomies (distal [48.2%], central [6.9%], cephalic [13.8%], enucleations [24.1%], ampullectomies [3.5%] and duodenal resections [3.5%]). In liver surgery the mean operative time was 204.4 minutes (100-265 min), the median postoperative complications according to the Clavien-Dindo scale was one (1-4), the mean blood losses 166.7 mL (100-300 mL), there was no conversion and the mean postoperative stay was four days (2-14 days). In pancreatic surgery, the mean operative time was 243.8 minutes (125-460 min), the median of postoperative complications was two (1-4), blood loss of 202.3 mL (100-500 mL) associated to a conversion rate 17.8% and an average stay of seven days (3-23 days). CONCLUSIONS Robotic HBP surgery is safe and feasible. It is suggested that its use facilitates parenchymal sparing surgery, access to posterior liver segments and anastomosis in pancreatic reconstruction compared to laparoscopic surgery.
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18
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Pardo Aranda F, Cugat Andorrà E, Cremades Pérez M, Zárate Pinedo A. Pancreas anastomosis after laparoscopic and robotic pancreatoduodenectomy. Cir Esp 2021. [PMID: 33390249 DOI: 10.1016/j.ciresp.2020.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Fernando Pardo Aranda
- Unidad Hepatobiliopancreática, Cirugía General y Digestiva, Hospital Universitario Germans Trias i Pujol, Barcelona, España.
| | - Esteban Cugat Andorrà
- Unidad Hepatobiliopancreática, Cirugía General y Digestiva, Hospital Universitario Germans Trias i Pujol, Barcelona, España
| | - Manel Cremades Pérez
- Unidad Hepatobiliopancreática, Cirugía General y Digestiva, Hospital Universitario Germans Trias i Pujol, Barcelona, España
| | - Alba Zárate Pinedo
- Unidad Hepatobiliopancreática, Cirugía General y Digestiva, Hospital Universitario Germans Trias i Pujol, Barcelona, España
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Espin Alvarez F, García Domingo MI, Cremades Pérez M, Herrero Fonollosa E, Navinés López J, Camps Lasa J, Pardo Aranda F, Cugat Andorrá E. Highs and lows in laparoscopic pancreaticoduodenectomy. Cir Esp 2020; 99:S0009-739X(20)30236-0. [PMID: 32958225 DOI: 10.1016/j.ciresp.2020.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/12/2020] [Revised: 06/12/2020] [Accepted: 07/13/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Laparoscopic pancreaticoduodenectomy (PD) is not widely accepted, and its use is controversial. Only correct patient selection and appropriate training of groups experienced in pancreatic surgery and laparoscopy will be able to establish its role and its hypothetical advantages METHODS: Out of 138 pancreatic surgeries performed in a two-year period (2017-2019), 23 were laparoscopic PD. We evaluate its efficacy and safety compared to 31 open PD. RESULTS There were no cases of B/C pancreatic or biliary fistula, nor any cases of delayed gastric emptying in the laparoscopic group, but hemorrhage required one reoperation. The conversion rate was 21% (five cases): one due to bleeding, and the remainder for non-progression. The converted patients showed no differences compared to those completed by laparoscopy. There were no differences between laparoscopic and open PD in surgical time, postoperative complications, reintervention rate, readmissions or mortality. R0 resection in tumor cases was 85% for laparoscopy and 69% in open surgery without statistical significance. The postoperative hospital stay was shorter in the laparoscopic PD group (eight vs. 15 days). CONCLUSIONS In a selected group, laparoscopic PD can be safely and effectively performed if carried out by groups who are experts in pancreatic surgery and advanced laparoscopy. The technique has the same postoperative results as open surgery and is oncologically adequate, with less hospital stay. Proper patient selection, a step-by-step program and a lax and early conversion prevents serious operating accidents.
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Affiliation(s)
- Francisco Espin Alvarez
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, España
| | - María Isabel García Domingo
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, España
| | - Manel Cremades Pérez
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, España.
| | - Eric Herrero Fonollosa
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, España
| | - Jordi Navinés López
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, España
| | - Judith Camps Lasa
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, España
| | - Fernando Pardo Aranda
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, España
| | - Esteban Cugat Andorrá
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, España; Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, España
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20
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Gené Škrabec C, Pardo Aranda F, Espín F, Cremades M, Navinés J, Zárate A, Cugat E. Fluorescent cholangiography with direct injection of indocyanine green (ICG) into the gallbladder: a safety method to outline biliary anatomy. Langenbecks Arch Surg 2020; 405:827-832. [PMID: 32827267 DOI: 10.1007/s00423-020-01967-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 05/08/2020] [Accepted: 08/12/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Near infrared cholangiography (NIRC) with indocyanine green (ICG) directly injected into the gallbladder is a novel technique to outline biliary anatomy. The purpose of this article is to analyze the usefulness and feasibility of NIRC as a safety method during laparoscopic cholecystectomies. MATERIAL AND METHODS A case-controlled study comparing 20 patients undergoing laparoscopic cholecystectomies with NIRC with direct injection of ICG into the gallbladder to 20 consecutive standard cholecystectomies. Operative time, length of stay, complications, conversion rates, and biliary injury were analyzed. RESULTS Both groups were comparable in epidemiological characteristics. In the ICG group fluorescent visualization of the junction of the Hartmann pouch and the whole cystic duct was achieved in 16 (80%) patients. Median surgical time was 65 (50-76) and 55 (45-71) min for the ICG and the control group, respectively (p = 0.113). There were no postoperative complications and no biliary duct injuries in any of the groups, and a patient from both groups underwent conversion to open surgery. CONCLUSION NIRC with direct injection of ICG into the gallbladder is a feasible method that is not time-consuming; it does not require a different learning curve from standard laparoscopic cholecystectomies and has no major complications described so far.
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Affiliation(s)
- Clara Gené Škrabec
- Department of General and Digestive Surgery, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Fernando Pardo Aranda
- Department of General and Digestive Surgery, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.
| | - Francisco Espín
- Department of General and Digestive Surgery, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Manel Cremades
- Department of General and Digestive Surgery, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Jordi Navinés
- Department of General and Digestive Surgery, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Alba Zárate
- Department of General and Digestive Surgery, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Esteban Cugat
- Department of General and Digestive Surgery, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.,Department of General and Digestive Surgery, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
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21
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Pardo Aranda F. A propósito de la carta científica «Sospecha de abdomen agudo como manifestación extrapulmonar de infección COVID-19». Cir Esp 2020; 98:423-424. [PMID: 32362365 PMCID: PMC7174190 DOI: 10.1016/j.ciresp.2020.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/19/2020] [Indexed: 11/26/2022]
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22
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Pardo Aranda F, Espín Álvarez F, Navines López J, Cugat Andorrà E. Outflow Control of the Right Hepatic Vein During Laparoscopic Right Hepatectomy. Cir Esp 2020; 99:310. [PMID: 32703530 DOI: 10.1016/j.ciresp.2020.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/01/2020] [Accepted: 06/13/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Fernando Pardo Aranda
- Unidad Hepatobiliopancreática, Cirugía General y Digestiva, Hospital Universitario Germans Trias i Pujol, Barcelona, España.
| | - Francisco Espín Álvarez
- Unidad Hepatobiliopancreática, Cirugía General y Digestiva, Hospital Universitario Germans Trias i Pujol, Barcelona, España
| | - Jordi Navines López
- Unidad Hepatobiliopancreática, Cirugía General y Digestiva, Hospital Universitario Germans Trias i Pujol, Barcelona, España
| | - Esteban Cugat Andorrà
- Unidad Hepatobiliopancreática, Cirugía General y Digestiva, Hospital Universitario Germans Trias i Pujol, Barcelona, España
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Pardo Aranda F, Larrañaga Blanc I, Rivero Déniz J, Trujillo JC, Rada Palomino A, García-Olivares E, Rami Porta R, Veloso EV. Tratamiento quirúrgico de metástasis suprarrenal sincrónica de cáncer de pulmón: adrenalectomía primero. Cir Esp 2017; 95:97-101. [DOI: 10.1016/j.ciresp.2017.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 12/31/2016] [Accepted: 01/07/2017] [Indexed: 02/03/2023]
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Pardo Aranda F, Maristany C, Pando JA, Muñoz-Duyos A, Navarro A, Puértolas N, Veloso EV. Application of Fast-Track Recovery Protocols in Single-Port Laparoscopic Surgery Versus Multiport Laparoscopic Surgery for Colon Resection. J Laparoendosc Adv Surg Tech A 2016; 26:424-7. [PMID: 27104363 DOI: 10.1089/lap.2015.0520] [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: 11/13/2022] Open
Abstract
AIM The aim of this study is to analyze whether fast-track (FT) recovery protocols can be applied to single-port laparoscopic surgery for colon resection, as they are in multiport laparoscopic surgery. MATERIALS AND METHODS Retrospective study comparing single-port laparoscopic surgery (SP-FT) versus multiport laparoscopic surgery (MP-FT) for colon resection, and the applicability of our FT recovery protocol in all patients between 2013 and 2014. Variables evaluated were American Society of Anesthesiologists (ASA) score, tumor size, number of nodes, surgery performed, postoperative morbidity, and length of hospital stay. RESULTS A total of 83 patients (28 SP-FT group and 55 MP-FT group) underwent FT recovery. The median age was 62 (11-85) years in SP-FT group and 72 (57-84) in MP-FT group. ASA score showed no significant difference (P = .973). The surgical procedures performed were as follows: SP-FT group 20 right hemicolectomy, 5 left hemicolectomy, and 3 subtotal colectomy and MP-FT group were 26 right hemicolectomy, 28 left hemicolectomy, and 1 subtotal colectomy. Mean operative time (minutes) was shorter in SP-FT group (151 ± 47.9 versus 182 ± 50.7), but no significant difference was observed. Regarding the tumor size (SP-FT 4.2 [2-7] cm versus MP-FT 4 [3-12] cm) and postoperative morbidity Clavien-Dindo ≥2 (SP-FT 10 patients versus MP-FT 20 patients), there were no significant differences (P = .535; P = .383). The median length of hospital stay was statistically significant: SP-FT 4.5 (3-53) days versus MP-FT 7 (4-33) days (P = .005). CONCLUSIONS FT rehabilitation is safe and reproducible in single-port laparoscopic surgery for colon pathologies, with postoperative results comparable with conventional laparoscopic surgery.
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Affiliation(s)
- Fernando Pardo Aranda
- Department of Gastrointestinal Surgery, Hospital Universitario Mutua Terrassa , Barcelona, Spain
| | - Carlos Maristany
- Department of Gastrointestinal Surgery, Hospital Universitario Mutua Terrassa , Barcelona, Spain
| | - Jose Antonio Pando
- Department of Gastrointestinal Surgery, Hospital Universitario Mutua Terrassa , Barcelona, Spain
| | - Arantxa Muñoz-Duyos
- Department of Gastrointestinal Surgery, Hospital Universitario Mutua Terrassa , Barcelona, Spain
| | - Alberto Navarro
- Department of Gastrointestinal Surgery, Hospital Universitario Mutua Terrassa , Barcelona, Spain
| | - Noelia Puértolas
- Department of Gastrointestinal Surgery, Hospital Universitario Mutua Terrassa , Barcelona, Spain
| | - Enrique Veloso Veloso
- Department of Gastrointestinal Surgery, Hospital Universitario Mutua Terrassa , Barcelona, Spain
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Muñoz Muñoz E, Pardo Aranda F, Camps Lasa J, Rodriguez Alsina X, Veloso Veloso E. Repair of large abdominal wall defects by epiploplasty and polypropelene mesh in patients with decompressive laparostomies. Cir Esp 2014; 93:204-6. [PMID: 24709076 DOI: 10.1016/j.ciresp.2014.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 01/29/2014] [Accepted: 02/20/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Emilio Muñoz Muñoz
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Mutua Terrassa, Terrassa, Barcelona, España
| | - Fernando Pardo Aranda
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Mutua Terrassa, Terrassa, Barcelona, España.
| | - Judith Camps Lasa
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Mutua Terrassa, Terrassa, Barcelona, España
| | - Xavier Rodriguez Alsina
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Mutua Terrassa, Terrassa, Barcelona, España
| | - Enrique Veloso Veloso
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Mutua Terrassa, Terrassa, Barcelona, España
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