Robotic liver surgery for minor hepatic resections: a comparison with laparoscopic and open standard procedures
Robotic liver surgery for minor hepatic resections: a comparison with laparoscopic and open standard procedures
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DOI：
10.1007/s00423-016-1440-1
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发表时间：
2016-08-01
影响因子：
2.3
通讯作者：
Brunner, Maximillian
中科院分区：
文献类型：
--
作者：
Croner, Roland S.;Perrakis, Aristotiles;Brunner, Maximillian
微创肝脏手术在全球范围内不断增加。机器人在这种情况下的好处目前正在讨论中。我们比较了我们的机器人病例与腹腔镜和开放式小肝切除术并分享经验。从2011年到2015年，埃尔兰根大学医院外科有10名患者接受了机器人手术，19名患者接受了腹腔镜小肝切除术。将这些患者与53例患者的病例匹配对照组进行比较。回顾性分析了围手术期前瞻性收集的数据，机器人（306 ml）和腹腔镜（356 ml）手术组与开放手术组（903 ml）相比失血量显著减少（p = 0.001）。所有组的平均肿瘤大小为4.1-4.8 cm（p = 0.571）。94%的开放手术组和100%的腹腔镜和机器人组存在阴性手术切缘（p = 0.882）。机器人手术（321分钟）与腹腔镜手术（242分钟）和开放手术（186分钟）相比，手术时间延长（p = 0.001）。机器人手术（7天）和腹腔镜手术（8天）与开放手术（10天）相比，术后住院率降低（p = 0.004）。开放手术的总发病率为17%，腹腔镜手术为16%，机器人手术为1%（p = 0.345）。微创手术与开放手术相比，术后止痛药和肝酶升高明显降低。微创肝脏手术可以安全地用于小肝切除，应尽可能考虑。小型肝切除术可以通过标准腹腔镜手术进行，相当于机器人手术。尽管如此，机器人增加了一项技术升级，这可能对具有挑战性的病例和重大肝脏手术有好处。
Minimally invasive liver surgery is increasing worldwide. The benefit of the robot in this scenario is currently controversially discussed. We compared our robotic cases vs. laparoscopic and open minor hepatic resections and share the experience.From 2011 to 2015, ten patients underwent robotic and 19 patients underwent laparoscopic minor liver resections in the Department of Surgery, University Hospital Erlangen. These patients were compared to a case-matched control group of 53 patients. The perioperative prospectively collected data were analyzed retrospectively.Blood loss was significantly decreased in the robotic (306 ml) and laparoscopic (356 ml) vs. the open (903 ml) surgery group (p = 0.001). Mean tumor size was 4.1-4.8 cm in all groups (p = 0.571). Negative surgical margins were present in 94 % of the open and 100 % of the laparoscopic and robotic group (p = 0.882). Time for surgery was enlarged for robotic (321 min) vs. laparoscopic (242 min) and open (186 min) surgery (p = 0.001). Postoperative hospitalization was decreased after robotic (7 days) and laparoscopic (8 days) vs. open (10 days) surgery (p = 0.004). Total morbidity was 17 % for open, 16 % for laparoscopic, and 1 % for robotic cases (p = 0.345). Postoperative pain medication and elevation of liver enzymes were remarkably lower after minimally invasive vs. open procedures.Minimally invasive liver surgery can be performed safely for minor hepatic resections and should be considered whenever possible. Minor liver resections can be performed by standard laparoscopy equivalent to robotic procedures. Nevertheless, the robot adds a technical upgrade which may have benefits for challenging cases and major liver surgery.