Safety and Feasibility Report of Robotic-Assisted Left Lateral Sectionectomy for Pediatric Living Donor Liver Transplantation: A Comparative Analysis of Learning Curves and Mastery Achieved With the Laparoscopic Approach.
Safety and Feasibility Report of Robotic-Assisted Left Lateral Sectionectomy for Pediatric Living Donor Liver Transplantation: A Comparative Analysis of Learning Curves and Mastery Achieved With the Laparoscopic Approach.
复制标题
机器人辅助儿童活体肝移植左外侧部分切除术的安全性和可行性报告：腹腔镜方法学习曲线和掌握程度的比较分析。
DOI：
10.1097/tp.0000000000003332
复制
发表时间：
2020
期刊：
影响因子：
6.2
通讯作者：
D. Broering
中科院分区：
文献类型：
--
作者：
R. Troisi;Yasser Elsheikh;Y. Alnemary;A. Zidan;M. Sturdevant;S. Alabbad;T. Algoufi;M. Shagrani;D. Broering
背景
人们对用于供体肝切除术的左外侧部分切除术（LLS）越来越感兴趣。没有关于机器人 (ROB) 方法安全性的数据。
方法
对 75 例连续微创供肝切除术进行了回顾性比较研究。我们将 2018 年 11 月至 2019 年 7 月期间进行的前 25 例机器人 (ROB) 手术与 2013 年 5 月至 2018 年 10 月期间进行的首例 (LAP1) 和最后 25 例 (LAP2) 腹腔镜手术进行了比较。分析了短期捐赠者和受者的结果。
结果
ROB 中未发现任何转化，而 LAP1 中记录了两次转化 (8%)，而 LAP2 中则没有记录。与 LAP1 相比，ROB 中的失血量显着减少 (p=<0.001)，但 LAP2 中则不然。相对于其他组，ROB 中的热缺血时间更长 (p=<0.001)。 3 组的手术时间相似 (p=0.080)；然而，ROB 的住院时间较短 (p=0.048)。与 LAP1 和 LAP2 相比，ROB 的手术时间趋势显着缩短：线性 R 0.478，p=<0.001； R 0.012，p=0.596； R 分别为 0.004，p=0.772。 ROB 中的供体发病率为零，LAP1 和 LAP2 中相似 (n=3-12%) (p=0.196)。 ROB 手术需要较少的术后镇痛 (p=0.002)。所有组的受者并发症相似（p=0.274），并且没有记录早期再移植。
结论
用于供体肝切除术的机器人 LLS 是一种安全的手术，当由专家执行该手术时，在供体发病率和总体受者结果方面，其结果可与腹腔镜检查相媲美。当然，目前它的用途非常有限。
BACKGROUND
There is a growing interest in left lateral sectionectomy (LLS) for donor hepatectomy. No data are available concerning the safety of the robotic (ROB) approach.
METHODS
A retrospective comparative study was conducted on 75 consecutive minimally invasive donor hepatectomies. The first 25 robotic (ROB) procedures performed from November 2018 to July 2019 were compared to our first (LAP1) and last 25 (LAP2) laparoscopic cases performed between May 2013 and October 2018. Short-term donors and recipients' outcomes were analyzed.
RESULTS
No conversions were noticed in ROB whereas two conversions (8%) were recorded in LAP1 and none in LAP2. Blood loss was significantly less in ROB compared to LAP1 (p=<0.001) but not in LAP2. Warm ischemia time was longer in ROB (p=<0.001) with respect to the other groups. Operative time was similar in the 3 groups (p=0.080); however, the hospital stay was shorter in ROB (p=0.048). The trend in operative time in ROB was significantly shorter compared to LAP1 and LAP2: linear R 0.478, p=<0.001; R 0.012, p=0.596; R 0.004, p=0.772, respectively. Donor morbidity was nihil in ROB, similar in LAP1 and LAP2 (n=3-12%) (p=0.196). ROB procedures required less postoperative analgesia (p=0.002). Recipients complications were similar for all groups (p=0.274) and no early re-transplantations were recorded.
CONCLUSIONS
Robotic LLS for donor hepatectomy is a safe procedure with results comparable to the laparoscopy in terms of donor morbidity and overall recipients' outcome when the procedure is performed by experts. Certainly, its use is currently very limited.