Robotic liver resection in the posterosuperior segments as a way to extent the mini-invasive arsenal: a comparison with transthoracic laparoscopic approach

Denglos, Pauline; Truant, Stéphanie; Amrani, M. El; Millet, Guillaume

doi:10.1007/s00464-023-09919-6

Cited by 2 publications

References 31 publications

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Liver parenchyma dissection in Totally robotic liver surgery - Results of the first 100 patients using the Robotic Harmonic curved shears

Fukumori,

Tschuor,

Penninga

et al. 2023

Mini-invasive Surg

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Aim: Robotic liver surgery (RLS) is a feasible and safe procedure. However, limitations of the robotic instruments used for liver parenchyma dissection compared to laparoscopic and open approaches are major drawbacks of RLS. There is no established technique for liver parenchymal dissection in RLS. The aim of this study is to discuss the surgical outcomes of Totally RLS using Robotic Harmonic curve shears at the University Hospital of Copenhagen, Denmark. Methods: Between June 2019 and June 2022, RLS was performed with 100 patients. Patient variables and short-term outcomes were retrospectively analysed. Results: The mean patient age was 63.1 years; the median operating time was 246 min; and the median estimated blood loss was 100 mL. Thirty-two patients underwent subsegmentectomy, 18 mono-segmentectomies, 25 bi-segmentectomies, and 25 major hepatectomies. One patient (1.0%) required conversion to open surgery. Five patients experienced postoperative major complications (Clavien-Dindo classification ≥ IIIa) while no mortalities occurred. Median length of hospital stay was 3 days. There were no significant differences between minor and major hepatectomies in any of the factors. Conclusion: Based on our study of minor and major hepatectomies in Totally RLS, we conclude that the use of the Robotic Harmonic curve shear for liver parenchyma dissection is feasible and safe.

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Liver parenchyma dissection in Totally robotic liver surgery - Results of the first 100 patients using the Robotic Harmonic curved shears

Fukumori,

Tschuor,

Penninga

et al. 2023

Mini-invasive Surg

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Clinical Outcomes of Robotic Posterosuperior Hepatectomy Compared to Major Hepatectomy: A Propensity Score-Matched Analysis of Liver Resection for Difficult Segments Using Robotic Platform.

Sucandy

Patel

Syblis

et al. 2023

Preprint

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Introduction: Minimally invasive resection of posterosuperior hepatic segments (i.e., segments VII and VIII) is a technically challenging operation due to limited visibility and accessibility. Therefore, this type of liver resection is mainly undertaken via a traditional open approach. We aimed to analyze the safety, feasibility, and efficacy of robotic posterosuperior resection and compare them with those of robotic major hepatectomy. Methods 128 patients undergoing robotic posterosuperior and major hepatectomy were included. Patient demographics, intra-, and postoperative outcomes were analyzed. Data are presented as median (mean ± SD). Results Robotic posterosuperior resection was undertaken in 32 patients, and these patients were propensity score-matched to 96 patients who underwent a robotic major hepatectomy. There were no significant differences in age, sex, BMI, past liver and abdominal operations, ASA, MELD score, Child-Pugh score, and number of patients with cirrhosis. In patients who underwent robotic posterosuperior resection versus major hepatectomy, there were no differences in the following intraoperative variables: operative duration (292 vs 281 minutes; p = 0.87), estimated blood loss (200 vs 175 mL; p = 0.32), and R1 status (0% vs 2%; p = 1.00). There were no open conversions. Postoperatively, there were no significant differences in outcomes, including Clavien-Dindo grade ≥ III complications (0% vs 4%; p = 0.57), length of stay (4 vs 4 days; p = 1.00), 30-day readmissions (22% vs 18%; p = 0.61), 30-and 90-day mortality (0% vs 1%; p = 1.00). The IWATE difficulty scores were significantly higher for the posterosuperior hepatectomies. Conclusions Robotic posterosuperior hepatectomy is safe, feasible, and effective with excellent clinical outcomes, similar to those of major hepatectomy.

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Robotic liver resection in the posterosuperior segments as a way to extent the mini-invasive arsenal: a comparison with transthoracic laparoscopic approach

Cited by 2 publications

References 31 publications

Liver parenchyma dissection in Totally robotic liver surgery - Results of the first 100 patients using the Robotic Harmonic curved shears

Liver parenchyma dissection in Totally robotic liver surgery - Results of the first 100 patients using the Robotic Harmonic curved shears

Clinical Outcomes of Robotic Posterosuperior Hepatectomy Compared to Major Hepatectomy: A Propensity Score-Matched Analysis of Liver Resection for Difficult Segments Using Robotic Platform.

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