Robotic versus laparoscopic hepatectomy: application of the difficulty scoring system
Robotic versus laparoscopic hepatectomy: application of the difficulty scoring system
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DOI：
10.1007/s00464-019-06976-8
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发表时间：
2020-05-01
影响因子：
3.1
通讯作者：
Lai, Paul B. S.
中科院分区：
文献类型：
--
作者：
Chong, Charing C. N.;Lok, H. T.;Lai, Paul B. S.
研究背景机器人系统的发展可能有助于减轻腹腔镜肝切除术中遇到的困难。开发了一个难度评分系统（DSS）来评估各种腹腔镜肝切除术的难度。本研究的目的是探讨DSS是否适用于机器人肝切除术，并比较不同难度水平的机器人肝切除术和腹腔镜肝切除术的结果。方法前瞻性收集并回顾在香港威尔斯亲王医院接受机器人和传统腹腔镜肝切除术的所有连续患者的临床数据。使用DSS对手术难度进行分级。在每个难度水平下比较机器人和传统腹腔镜肝切除术的围手术期结局。结果在研究期间，分别有107例和94例患者接受了机器人和腹腔镜肝切除术。其中，16例和2例患者分别因复发性化脓性胆管炎而手术，并因无法指定肿瘤位置而被排除。对于机器人肝切除术，较高的DSS与较高的轻微并发症发生率（p = 0.001）、较多的术中失血量（p = 0.002）、较长的手术时间（p < 0.001）和较长的术后住院时间（p < 0.001）显著相关。机器人和腹腔镜肝切除术的平均DSS评分分别为4.5和3.6。（p = 0.004）。对于低难度（DSS 1-3）和中等难度（DSS 4-6）的病例，手术失血量、手术时间和总体并发症发生率无显著差异。仅2例（2.2%）难度较高的患者采用腹腔镜手术，而20%的患者采用机器人手术，DSS > 6。结论DSS与机器人肝切除术的手术效果显著相关。机器人和传统腹腔镜肝切除术后的围手术期结局在低难度和中等难度的病例中相似。然而，机器人系统允许在难度较高的情况下进行微创手术。
Background The development of robotic system may help to relieve the difficulties encountered during laparoscopic hepatectomy. A difficulty scoring system (DSS) was developed to assess the difficulty of various laparoscopic liver resection procedures. The aim of this study is to explore if the DSS is applicable in robotic hepatectomy and to compare the outcomes of robotic hepatectomy and laparoscopic hepatectomy among different difficulty levels. Methods Clinical data from all consecutive patients who underwent robotic and conventional laparoscopic hepatectomy at the Prince of Wales Hospital, Hong Kong, were prospectively collected and reviewed. The difficulty level of operations was graded using the DSS. Perioperative outcomes of robotic and conventional laparoscopic hepatectomy were compared at each difficulty level. Results A total of 107 and 94 patients underwent robotic and laparoscopic hepatectomy during the study period, respectively. Among them, 16 and 2 patients were operated for recurrent pyogenic cholangitis, respectively, and were excluded because no mark for tumour location can be assigned. For robotic hepatectomy, a higher DSS was significantly correlated with higher minor complication rate (p = 0.001), more intraoperative blood loss (p = 0.002), longer operation time (p < 0.001) and longer post-operative hospital stay (p < 0.001). The mean DSS scores of robotic and laparoscopic hepatectomy were 4.5 and 3.6, respectively. (p = 0.004). For cases with low (DSS 1-3) and intermediate (DSS 4-6) difficulty level, there was no significant difference in operative blood loss, operation time and overall complications rate. Only 2 cases (2.2%) with high difficulty level were operated with laparoscopic approach while 20% of patients operated with robotic approach had DSS > 6. Conclusions DSS significantly correlated with surgical outcomes in patient who underwent robotic hepatectomy. Perioperative outcomes following robotic and conventional laparoscopic hepatectomy were similar in cases with low and intermediate difficulty. However, robotic system allowed minimally invasive approach in cases with higher difficulty level.