Applying IWATE criteria to robotic hepatectomy: is there a “robotic effect”?

Luberice, Kenneth; Sucandy, Iswanto; Modasi, Aryan; Castro, Miguel Ángel; Krill, Emily; Ross, Sharona; Rosemurgy, Alexander S.

doi:10.1016/j.hpb.2020.10.008

Cited by 23 publications

(31 citation statements)

References 6 publications

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“…Robotic approach has greater intraoperative costs but this is outbalanced by a lower postoperative cost conferred by lower complication rate and shorter hospital stay (15,(17)(18)(19)(20) . This robotic effect on outcome, according to Luberice et al (7) , is independent of difficulty level of the liver resection. It has been noted by us since the inception of our robotic program and shown by these authors with their analysis of Iwate criteria of laparoscopic liver resection difficulty applied to robotic hepatectomy (7) .…”

Section: Discussionmentioning

confidence: 80%

“…This robotic effect on outcome, according to Luberice et al (7) , is independent of difficulty level of the liver resection. It has been noted by us since the inception of our robotic program and shown by these authors with their analysis of Iwate criteria of laparoscopic liver resection difficulty applied to robotic hepatectomy (7) .…”

Section: Discussionmentioning

confidence: 80%

“…Since May 2018, all our minimally invasive liver surgeries are performed using the robotic platform and their data has been recorded on a prospective maintained database. Our experience with this new system increased over this period and so the indications for more complex cases (7)(8)(9)(10) . The robotic approach, with its added degrees of freedom and stability of the robotic platform, may offer options for minimally invasive performance of complex liver resections that were a relative contraindication of laparoscopy (15)(16)(17) .…”

Section: Discussionmentioning

confidence: 99%

“…There is a recent interest in robotic liver surgery and the number and complexity of procedures are rapidly increasing (6)(7)(8)(9)(10) . The aim of this paper is to report the experience with our first fifty robotic liver resections.…”

Section: Introductionmentioning

confidence: 99%

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Robotic Liver Resection. Report of the First 50 Cases

Machado

Filho

Mattos

et al. 2021

Arq. Gastroenterol.

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BACKGROUND: Robotic surgery has gained growing acceptance in recent years, expanding to liver resection. OBJECTIVE: The aim of this paper is to report the experience with our first fifty robotic liver resections. METHODS: This was a single-cohort, retrospective study. From May 2018 to December 2020, 50 consecutive patients underwent robotic liver resection in a single center. All patients with indication for minimally invasive liver resection underwent robotic hepatectomy. The indication for the use of minimally invasive technique followed practical guidelines based on the second international laparoscopic liver consensus conference. RESULTS: The proportion of robotic liver resection was 58.8% of all liver resections. Thirty women and 20 men with median age of 61 years underwent robotic liver resection. Forty-two patients were operated on for malignant diseases. Major liver resection was performed in 16 (32%) patients. Intrahepatic Glissonian approach was used in 28 patients for anatomical resection. In sixteen patients, the robotic liver resection was a redo hepatectomy. In 10 patients, previous liver resection was an open resection and in six it was minimally invasive resection. Simultaneous colon resection was done in three patients. One patient was converted to open resection. Two patients received blood transfusion. Four (8%) patients presented postoperative complications. No 90-day mortality was observed. CONCLUSION: The use of the robot for liver surgery allowed to perform increasingly difficult procedures with similar outcomes of less difficult liver resections.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Robotic Liver Resection. Report of the First 50 Cases

Machado

Filho

Mattos

et al. 2021

Arq. Gastroenterol.

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“…To study the complexity of the RLRs performed, we employed the IWATE score. The effectiveness of the IWATE score as an indicator of operative difficulty in LLR has been demonstrated and several groups have previously considered that its usefulness in laparoscopic liver surgery could be extrapolated to the robotic approach[ 26 , 27 ]. In this study, 45% of the procedures were classified as advanced and expert.…”

Section: Discussionmentioning

confidence: 99%

Can the computed tomography texture analysis of colorectal liver metastases predict the response to first-line cytotoxic chemotherapy?

Rabe¹,

Cioni²,

Baglietto³

et al. 2022

WJH

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BACKGROUND Liver surgery has traditionally been characterized by the complexity of its procedures and potentially high rates of morbidity and mortality in inexperienced hands. The robotic approach has gradually been introduced in liver surgery and has increased notably in recent years. However, few centers currently perform robotic liver surgery and experiences in robot-assisted surgical procedures continue to be limited compared to the laparoscopic approach. AIM To analyze the outcomes and feasibility of an initial robotic liver program implemented in an experienced laparoscopic hepatobiliary center. METHODS A total of forty consecutive patients underwent robotic liver resection (da Vinci Xi, intuitive.com, United States) between June 2019 and January 2021. Patients were prospectively followed and retrospectively reviewed. Clinicopathological characteristics and perioperative and short-term outcomes were analyzed. Data are expressed as mean and standard deviation. The study was approved by the Institutional Review Board. RESULTS The mean age of patients was 59.55 years, of which 18 (45%) were female. The mean body mass index was 29.41 kg/m². Nine patients (22.5%) were cirrhotic. Patients were divided by type of resection as follows: Ten segmentectomies, three wedge resections, ten left lateral sectionectomies, six bisegmentectomies (two V-VI bisegmentectomies and four IVb-V bisegmentectomies), two right anterior sectionectomies, five left hepatectomies and two right hepatectomies. Malignant lesions occurred in twenty-nine (72.5%) of the patients. The mean operative time was 258.11 min and two patients were transfused intraoperatively (5%). Inflow occlusion was used in thirty cases (75%) and the mean total clamping time was 32.62 min. There was a single conversion due to uncontrollable hemorrhage. Major postoperative complications (Clavien–Dindo > IIIb) occurred in three patients (7.5%) and mortality in one (2.5%). No patient required readmission to the hospital. The mean hospital stay was 5.6 d. CONCLUSION Although robotic hepatectomy is a safe and feasible procedure with favorable short-term outcomes, it involves a demanding learning curve that requires a high level of training, skill and dexterity.

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Safety and Efficacy of Robotic vs Open Liver Resection for Hepatocellular Carcinoma

et al. 2023

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ImportanceLong-term oncologic outcomes of robotic surgery remain a hotly debated topic in surgical oncology, but sparse data have been published thus far.ObjectiveTo analyze short- and long-term outcomes of robotic liver resection (RLR) for hepatocellular carcinoma (HCC) from Western high-volume centers to assess the safety, reproducibility, and oncologic efficacy of this technique.Design, Setting, and ParticipantsThis cohort study evaluated the outcomes of patients receiving RLR vs open liver resection (OLR) for HCC between 2010 and 2020 in 5 high-volume centers. After 1:1 propensity score matching, a group of patients who underwent RLR was compared with a validation cohort of OLR patients from a high-volume center that did not perform RLR.Main Outcomes and MeasuresA retrospective analysis was performed of prospectively maintained databases at 2 European and 2 US institutions of patients who underwent RLR for HCC between January 1, 2010, and September 30, 2020. The main outcomes were safety and feasibility of RLR for HCC and its oncologic outcomes compared with a European OLR validation cohort. A 2-sided P &lt; .05 was considered significant.ResultsThe study included 398 patients (RLR group: 125 men, 33 women, median [IQR] age, 66 [58-71] years; OLR group: 315 men, 83 women; median [IQR] age, 70 [64-74] years), and 106 RLR patients were compared with 106 OLR patients after propensity score matching. The RLR patients had a significantly longer operative time (median [IQR], 295 [190-370] minutes vs 200 [165-255] minutes, including docking; P &lt; .001) but a significantly shorter hospital length of stay (median [IQR], 4 [3-6] days vs 10 [7-13] days; P &lt; .001) and a lower number of admissions to the intensive care unit (7 [6.6%] vs 21 [19.8%]; P = .002). Incidence of posthepatectomy liver failure was significantly lower in the RLR group (8 [7.5%] vs 30 [28.3%]; P = .001), with no cases of grade C failure. The 90-day overall survival rate was comparable between the 2 groups (RLR, 99.1% [95% CI, 93.5%-99.9%]; OLR, 97.1% [95% CI, 91.3%-99.1%]), as was the cumulative incidence of death related to tumor recurrence (RLR, 8.8% [95% CI, 3.1%-18.3%]; OLR, 10.2% [95% CI, 4.9%-17.7%]).Conclusions and RelevanceThis study represents the largest Western experience to date of full RLR for HCC. Compared with OLR, RLR performed in tertiary centers represents a safe treatment strategy for patients with HCC and those with compromised liver function while achieving oncologic efficacy.

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Applying IWATE criteria to robotic hepatectomy: is there a “robotic effect”?

Cited by 23 publications

References 6 publications

Robotic Liver Resection. Report of the First 50 Cases

Robotic Liver Resection. Report of the First 50 Cases

Can the computed tomography texture analysis of colorectal liver metastases predict the response to first-line cytotoxic chemotherapy?

Safety and Efficacy of Robotic vs Open Liver Resection for Hepatocellular Carcinoma

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