ABSTRACT
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.
Keywords:
Liver; robotic surgical procedures; liver resection
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A) Foley catheter is used for intermittent intracorporeal Pringle maneuver.B) Indocyanine green fluorescence imaging during robotic left hepatectomy. Left liver is ischemic.C) Liver is transected with a combination of robotic bipolar forceps under continuous saline irrigation and robotic scissors.D) Intraoperative control of major bleeding from inferior vena cava (IVC) branch. IVC is temporary clamped, and a suture is placed.
A) Right hepatic artery (HA) is dissected and ligated during robotic right hepatectomy.B) Right portal vein (PV) is dissected and ligated during robotic right hepatectomy.C) Right bile duct (BD) is identified during liver transection, encircled, and ligated.D) Final aspect of hilar lymphadenectomy during robotic left hepatectomy for intrahepatic cholangiocarcinoma.
A) Left Glissonian pedicle is encircled during robotic left hepatectomy.B) Right Glissonian pedicle is encircled during robotic right hepatectomy.C) Glissonian pedicle from segment 3 (S3) and segment 2 (S2) are encircled during bi-segmentectomy 2-3.D) Glissonian pedicle from segment 1 (S1) is ligated during segmentectomy 1.
A) Machado’s points used for intrahepatic access to Glissonian pedicles from right liver.B) Machado’s points used for intrahepatic access to Glissonian pedicles from left liver.C) Schematic drawing of caudal view for intrahepatic access of right Glissonian pedicle.D) Schematic drawing of caudal view for intrahepatic access of left Glissonian pedicle.
A) Final view after robotic left trisegmentectomy with caudate lobe preservation. CT: common trunk, containing middle and left hepatic veins.B) Final view after robotic bi-segmentectomy 7-8. IVC: inferior vena cava; RHV: right hepatic vein.C) Final view after robotic right hepatectomy. Falciform ligament is sutured to the abdominal wall to maintain the left liver (remnant) in its original position avoiding hepatic vein kinking.D) Final view after robotic bi-segmentectomy 2-3. S1: segment 1; S4: segment 4.