Introduction
Although the laparoscopy liver resection (LLR) has become a useful approach for minor resections, it seems that lesions in posterosuperior (PS) segments still represent technical challenges. We report a series of robotic approach as an alternative option for these lesions, and a systematic review of the literature to show its feasibility.
Methods
Consecutive patients who underwent liver resection for solitary lesions in PS segments by da Vinci SI robot, and by the same team. A systematic review of the literature was made to evaluate the feasibility of a robotic approach for PS hepatectomies.
Results
From April 2016 to April 2017, five cases of robotic nonanatomical PS resections of colorectal liver metastases (CRLM) were performed. A systematic review encountered five articles plus this series reporting outcomes for this approach. Briefly, a total of five patients in our series underwent this approach, all females, and one patient presented a grade 2 complication.
Conclusion
Robotic hepatectomy seems to be a useful and valid strategy to resect lesions on PS hepatic segments simplifying liver‐sparing hepatectomies. Even though the operative time is still high, the short length of stay, low number of complications and the low need for blood transfusions seems to surpass the intrinsic cost of robotic surgery.
The benefits of laparoscopic approaches to treat colorectal cancer (CRC) and colorectal liver metastases (CRLM) separately are well established. However, there is no consensus about the optimal timing to approach the primary tumor and CRLM, whether simultaneously or staged. The objective of this review with practical reports is to discuss technical aspects required for patient selection to perform simultaneous laparoscopic approaches for CRC and CRLM. Methods: Literature review of oncological factors associated with patient selection for surgical treatment of CRLM and the use of laparoscopy in those cases, and report of technical aspects for simultaneous CRC and CRLM approaches. Results: Simultaneous laparoscopic resection has been successful in many series of selected patients, although it seems to be safer to perform minor and major liver resection with non-extended colorectal resections, and to avoid two high-risk procedures at the same time. Conclusions: Simultaneous CRC and CRLM resections seem to be safe when patients are carefully selected, also considering the risk of recurrence concerning oncologic outcomes. The pre-planning of simultaneous resection is mandatory to plan trocar positioning, procedure sequencing, and patient position.
Results: Shorter length of stay was observed in the early LC group (4.0 days versus 4.5 days. The mean total provider cost for early LC was RM 2532, and RM 2751 for elective LC. This difference was mostly seen in the consumable cost (i.e investigations and operating equipment) with p < 0.05. Operative outcome was statistically similar in each group in terms of conversion rate (23.1% vs. 18%), post-operative complications (11.5% vs 4.5%) and readmission rate (7.7% vs. 4.5%) with p > 0.05. However the operative time was statistically longer in the early LC group (134.2 + 48.5 minutes) versus elective group (105.9 + 40.1 minutes)(p = 0.032). Conclusion: The average provider's cost for early LC was statistically similar when compared to elective LC with comparable safety profile. Early LC should still be the preferred treatment option for patients with acute cholecystitis if adequate facilities and expertise is available.
Introduction: Although liver laparoscopy has become a useful approach for minor resections, it seems that lesions in upper and posterior segments still represent technical challenges. We report robotic approach for these lesions. Methods: Consecutive patients who underwent liver resection for solitary lesions in posterior and upper segments by daVinci Ò SI robot, and by the same team. All patients were placed in oblique left lateral position and reverse Trendelenburg to access the posterior and upper segments; five trocars were used (3 of 8 mm and 2 of 12 mm), and surgical specimens were removed through Pfannestiel incisions. Results: From April 2016 to April 2017, five female patients undergone robotic non-anatomical resections of colorectal liver metastases were reported. Clinicopathological, operative and postoperative data are summarized in the Table 1. Briefly, 4 patients presented isolated lesions in posterior segments and 1 patient in VII/VIII location, and the mean size was 2.3 cm. The difficulty score system (Iwate criteria) ranged from 2 to 6. Intraoperative ultrasound was used in all procedures and confirmed isolated lesions and their anatomical relations. Neither blood transfusion nor Pringle maneuver were necessary. One patient (20%) presented complication (pulmonary embolism e Dindo-Clavien grade 2). Conclusion: The putative benefits of robotic approach arises from the articulate arms allowing the use of mono and bipolar energy to help both exposition and liver parenchyma transection. They were useful even with the use of non-articulated harmonic scalpel. It seems that robotic approach is a valid option to potentially overcome the drawbacks of laparoscopy for those segments.
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