Parenchymal transection in robotic liver resection: results of 70 resections using the Vessel Sealer

Abstract

Aim: There is no standard technique for transection of the hepatic parenchyma during robotic liver resection. The aim of this study was to describe the outcomes of robotic liver resections using the Vessel Sealer for parenchymal transection. Methods: This is a post hoc analysis of a prospective database. All consecutive patients who underwent robotic liver resection in the Regional Academic Cancer Centre, Utrecht, Netherlands, between August 2015 and January 2019 were included. Results: A total of 70 robotic liver resections were performed, including 60 minor resections (86%) and ten hemihepatectomies (14%). Five procedures (7%) were converted. Mean parenchymal transection time was 43 ± 26 min. Median blood loss was 150 mL (interquartile range 40-300). Ten patients (14%) suffered from a major complication, and three patients (4%) had bile leakage postoperatively. One patient died from post-hepatectomy liver failure. Conclusion: Based on the results of this series, consisting of 60 minor liver resections and 10 hemihepatectomies, we conclude that the use of the Vessel Sealer during the parenchymal transection in liver resection is feasible and safe.

Robotic-Assisted Surgery for Primary Hepatobiliary Tumors—Possibilities and Limitations

“…Nota et al could demonstrate that the Vessel Sealer is generally employable for parenchymal bile ducts, portal branches, and veins but a stapler and/or hemolocks are used for inflow/outflow pedicles, major veins, or when larger vascular structures are encountered that are clearly beyond a size that could easily be sealed with a margin within the length of the sealer’s surface at 90 degrees. The authors therefore conclude that the Vessel Sealer is appropriate to seal most vascular structures encountered within the parenchyma of the liver segments [ 71 ].…”

Total robotic right hepatectomy for multifocal hepatocellular carcinoma using vessel sealer

“…However, outcomes were not discussed for different transection techniques. Nota et al [ 2 ] have used VS exclusively in their series of 70 liver resections. Among them, only 10 (14%) were major hepatectomies with a conversion rate of 7%.…”

“…Among them, only 10 (14%) were major hepatectomies with a conversion rate of 7%. They reported that 14% suffered from a major complication [ 2 ]. They did not encounter any technical difficulty or instrument failure when using the VS.…”

“…CUSA requires another experienced laparoscopic surgeon as an assistant, while a harmonic scalpel lacks articulation. MBF seem not optimally suited for bigger transection planes [ 2 ]. There is a paucity of literature on liver resection using an EndoWrist ® One™ Vessel Sealer (Intuitive Surgical).…”

‘Burn and Push’ technique: A novel robotic liver parenchymal transection technique

“…1,2 Despite these advancements, liver parenchymal transection during robotic liver resection (RLR) remains a significant challenge, mainly because of a limited range of robotic instruments specifically designed for liver parenchymal transection, and the lack of a standardised technique. [3][4][5] Various methods have been explored, such as saline-linked monopolar cautery scissors, 3 the saline-linked bipolar clamp-crush technique, 4 cavitron ultrasonic surgical aspirator (CUSA; Integra Life Sciences, Tullamore, Ireland), 6 ultrasonic coagulation and incision devices (Harmonic; Intuitive Surgical, Sunnyvale, CA, USA), 7 the radiofrequency energy device (Vessel Sealer; Intuitive Surgical, Sunnyvale, CA, USA), 8 and waterjet (Erbejet; Erbe Elektromedizin GmbH, Tuebingen, Germany), 9 each presenting its own set of benefits and limitations. For example, the robotic Harmonic scalpel lacks an pathological data, and postoperative outcomes were collected from the patient's electronic medical records.…”