1,721,034 research outputs found
Robot-assisted liver resections. Lessons learned from 127 procedures: short-term and long-term outcomes and literature review.
No full textBackground Liver surgery greatly evolved over the last decades, with significant reduction in operative morbidity and mortality. Minimally invasive liver surgery demonstrated to be safe and feasible for selected patients with equivalent oncologic outcomes compared to open surgery, despite requiring specific technical skills. Recently, robotic technology was used also to perform liver surgery, showing interesting aspects, such as flexibility and precision of surgical instruments and 3D vision, which appeared very helpful in performing challenging minimally invasive procedures. The present paper is a retrospective analysis of a seven years’personal experience in robotic liver surgery. Materials and methods: Over the last 7 years, from September 2012 to September 2019, we treated 127 patients affected by both benign and malignant liver diseases using robotic-assisted surgery. Patients’ characteristics, surgical procedures data and post-operative parameters were collected in a dedicated database. A retrospective analysis was performed to evaluate the outcomes in the robotic series. Results: Seventy-five patients were males and 52 females. The mean age was 66.3 years (range 21- 89). Patients undergoing surgery for malignancy were 97 (76%): 67 liver metastases (colorectal and others), 22 hepatocellular carcinomas (HCC), 5 cholangiocarcinomas (CCC), 3 gallbladder cancers. In 13 of them the final pathologic examination revealed benign lesions. Patients who underwent surgery for benign disease were 30 (24%): 15 biliary cystadenomas, 6 hydatid cysts, 3 hemangiomas, 4 symptomatic simple giant liver cysts, one focal nodular hyperplasia (FNH) and one adenoma. The overall liver lesions removed by robotic approach were 198: 63% of patients had more than one lesion. The median tumor size was 24,8 mm (range 4-92). Major hepatic resections were 20 (15.7%). Lesions involving posterior or paracaval segments (segments: 1, 4a, 7, 8) were 66 over 198 (33.3%). Twenty-seven patients (21.3%) had a previous open abdominal surgery with significant abdominal adhesions. Associated abdominal or thoracic diseases (excluding adhesions) treated during liver resections were 71: 25 colo-rectal resections, 22 cholecistectomies, 7 lymphadenectomy, 6 gastric resections, 2 lung resections, and other procedures. Inflow vascular pedicle control (Pringle maneuver) was performed in 37.8%. Mean estimated blood loss was 55 ml (range 5-1200). Intraoperative or perioperative transfusion request occurred in 8 cases (6.3%). Conversion to open surgery occurred in 11 patients (8.7%). Clavien-Dindo 3-4 grade complications occurred in 8.7%. Only one postoperative biliary leakage was observed (0.8%). One case of postoperative 90-day mortality was reported, related to liver failure at 52th post-operative day in a cirrhotic man who underwent a right hepatectomy. Conclusions. Robotic liver surgery is a safe and feasible approach which may increase the possibility of minimally invasive liver resection even in cases considered challenging for conventional laparoscopy, in particular for: lesions located in right postero-lateral and para-caval segments, major liver resections and associated abdominal procedures. The robotic assistance is useful especially for vascular control during tissue dissection and for micro-suturing, when required. The current lack of dedicated robotic instruments, in particular for parenchyma dissection, remains one of the most important shortfall, as well as the high costs and the devices availability. Further clinical comparative studies between robotic and laparoscopic approach are necessary
Minimally invasive liver resection: has the time come to consider robotics a valid assistance?
No full textMinimally invasive liver resection (MILR) has been steadily increasing worldwide. Since its introduction in the early 1990s, initially adopted in cases of wedge and minor anatomical resection for benign hepatic lesions, MILR has been extended to major liver resection and for malignant hepatic lesions (1). Laparoscopic lateral sectionectomy has progressively become a standard operatio
Robotic-assisted transperitoneal nephron-sparing surgery for small renal masses with associated surgical procedures: surgical technique and preliminary experience
No full textSmall renal masses (T1a) are commonly diagnosed incidentally and can be treated with nephron-sparing surgery, preserving renal function and obtaining the same oncological results as radical surgery. Bigger lesions (T1b) may be treated in particular situations with a conservative approach too. We present our surgical technique based on robotic assistance for nephron-sparing surgery. We retrospectively analysed our series of 32 consecutive patients (two with 2 tumours and one with 4 bilateral tumours), for a total of 37 robotic nephron-sparing surgery (RNSS) performed between June 2008 and July 2012 by a single surgeon (G.C.). The technique differs depending on tumour site and size. The mean tumour size was 3.6 cm; according to the R.E.N.A.L. Nephrometry Score 9 procedures were considered of low, 14 of moderate and 9 of hight complexity with no conversion in open surgery. Vascular clamping was performed in 22 cases with a mean warm ischemia time of 21.5 min and the mean total procedure time was 149.2 min. Mean estimated blood loss was 187.1 ml. Mean hospital stay was 4.4 days. Histopathological evaluation confirmed 19 cases of clear cell carcinoma (all the multiple tumours were of this nature), 3 chromophobe tumours, 1 collecting duct carcinoma, 5 oncocytomas, 1 leiomyoma, 1 cavernous haemangioma and 2 benign cysts. Associated surgical procedures were performed in 10 cases (4 cholecystectomies, 3 important lyses of peritoneal adhesions, 1 adnexectomy, 1 right hemicolectomy, 1 hepatic resection). The mean follow-up time was 28.1 months ± 12.3 (range 6-54). Intraoperative complications were 3 cases of important bleeding not requiring conversion to open or transfusions. Regarding post-operative complications, there were a bowel occlusion, 1 pleural effusion, 2 pararenal hematoma, 3 asymptomatic DVT (deep vein thrombosis) and 1 transient increase in creatinine level. There was no evidence of tumour recurrence in the follow-up. RNSS is a safe and feasible technique. Challenging situations are hilar, posterior or intraparenchymal tumour localization. In our experience, robotic technology made possible a safe minimally invasive management, including vascular clamping, tumour resection and parenchyma reconstruction
Robot-assisted laparoscopic total and partial gastric resection with D2 lymph node dissection for adenocarcinoma
No full textNon-cirrhotic liver tolerance to intermittent inflow occlusion during laparoscopic liver resection
No full textWhile inflow occlusion techniques are accepted methods to reduce bleeding during open liver surgery, their use in laparoscopic liver resections are limited by possible effects of pneumoperitoneum on ischemia-reperfusion liver damage. This retrospective study was designed to investigate the impact of intermittent pedicle clamping (IPC) on patients with normal liver undergoing minor laparoscopic liver resections. Three matched groups of patients were retrospectively selected from our in-house database: 11 patients who underwent robot-assisted liver resection with IPC, and 16 and 11 patients who underwent robot-assisted liver resection without IPC and open liver resection with IPC, respectively. The primary end point was to assess differences in postoperative serum alanine, aspartate aminotransferase (ALT and AST) and bilirubin levels. The curves of serum AST, ALT and bilirubin levels in a span of time of five postoperative days were not significantly different between the three groups. IPC has no relevant effects on ischemia-reperfusion liver damage even in the presence of pneumoperitoneum. © 2011 Springer-Verlag
Laparoscopic and robot-assisted one-stage resection of colorectal cancer with synchronous liver metastases: A pilot study
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