Robotic-Assisted Laparoscopic Anatomic Hepatectomy in China Initial Experience
Robotic-Assisted Laparoscopic Anatomic Hepatectomy in China Initial Experience
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DOI：
10.1097/sla.0b013e3181ff4601
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发表时间：
2011-02-01
影响因子：
9
通讯作者：
Dong, Jia-hong
中科院分区：
文献类型：
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作者：
Ji, Wen-bin;Wang, Hong-guang;Dong, Jia-hong
目的：评估机器人辅助腹腔镜解剖肝切除术的可行性和安全性。背景：微创手术的发展导致腹腔镜肝切除术的使用增加。然而，腹腔镜肝切除术在技术上仍然具有挑战性，并且尚未得到广泛发展。机器人手术代表了微创手术的最新发展，其越来越多地用于复杂的微创手术程序。在此，我们报告我们的初步经验，机器人辅助腹腔镜解剖肝切除术在13个连续patients.Patients和方法：2009年4月至7月，连续13例患者进行了机器人辅助腹腔镜解剖肝切除术的良性和恶性肝脏疾病。肝大部切除9例，肝左外叶切除4例。恶性肿瘤行肝大部切除8例，良性肿瘤行肝大部切除5例（左肝切除1例，左肝外叶切除4例）。所有机器人辅助肝切除手术均在解剖学上进行，并进行肝门解剖。在开始实质处理之前，尽可能对门静脉进行血管控制。这些机器人辅助腹腔镜解剖肝切除术与20个传统的腹腔镜肝切除术和32个开放切除术，同期和cohort matched.Results：所有13个机器人辅助腹腔镜解剖肝切除术进行了比较，成功地在纯腹腔镜切除的方式。无中转开腹手术或手助腹腔镜切除。尽管手术时间较长（338分钟）和更高的住院费用（12，046美元），机器人肝脏手术在失血方面优于传统的腹腔镜肝切除术和开放性切除术（280 vs. 350，470 mL），输血要求（0 vs. 3/20，4/32）、使用Pringle手法（0 vs. 3/20，6/32）和总体手术并发症（7.8% vs. 10%，12.5%）。机器人组既没有腹水也没有短暂的肝失代偿。所有8例恶性病变患者的手术切缘均为阴性，到目前为止，在机器人组中未观察到肝内复发或转移。传统腹腔镜手术的平均术后住院时间（5.2天）短于机器人手术（6.7天）或开放手术（9.6天）。从传统的腹腔镜开放和手助腹腔镜切除术发生在2例（10.0%）谁接受右半肝切除术和左hepatectomy.Conclusions：这些初步结果表明，机器人辅助腹腔镜解剖肝切除术是安全可行的，并发症和转换率比传统的腹腔镜肝切除术或开放切除术低得多。机器人手术系统可以拓宽腹腔镜肝切除术的适应症，并且它使外科医生能够执行精确的腹腔镜肝切除术，需要进行肝门解剖、肝腔解剖、内窥镜下切除和微吻合。然而，需要更长期的循证结果来证明其有效性，并且仍需要对其成本效益进行进一步研究。
Objective: To assess the feasibility and safety of robotic-assisted laparoscopic anatomic hepatectomy.Background: The development of minimally invasive surgery has led to an increase in the use of laparoscopic hepatectomy. However, laparoscopic hepatectomy remains technically challenging and is not widely developed. Robotic surgery represents a recent evolution in minimally invasive surgery that is being used increasingly for complex minimally invasive surgical procedures. Herein, we report our initial experience with robotic-assisted laparoscopic anatomic hepatectomy in 13 consecutive patients.Patients and Methods: Between April and July 2009, 13 consecutive patients underwent robotic-assisted laparoscopic anatomic hepatectomies for benign and malignant hepatic diseases. Major hepatectomies were performed in 9 patients, left lateral sectionectomies in 4 patients. Eight major hepatectomies were for malignant diseases and 5 hepatectomies (1 left hepatectomy and 4 left lateral sectionectomies) were for benign diseases. All the robotic-assisted hepatectomy procedures were performed anatomically with hilum dissection. Prior to starting the parenchymal transaction, vascular control of the portal vessels was carried out whenever possible. These robotic-assisted laparoscopic anatomic hepatectomies were compared with 20 traditional laparoscopic hepatectomies and 32 open resections that were contemporaneous and cohort-matched.Results: All 13 robotic-assisted laparoscopic anatomic hepatectomies were performed successfully in the manner of pure laparoscopic resection. No conversion to laparotomy or hand-assisted laparoscopic resection occurred. Despite its longer operative time (338 minutes) and higher hospital cost ($12,046), robotic liver surgery compared favorably with traditional laparoscopic hepatectomy and open resection in blood loss (280 vs. 350, 470 mL), transfusion requirement (0 vs. 3 of 20, 4 of 32), use of the Pringle maneuver (0 vs. 3 of 20, 6 of 32) and overall operative complications (7.8% vs. 10%, 12.5%). Neither ascites nor transient hepatic decompensation occurred in the robotic group. The surgical margins in all 8 patients with malignant lesions were negative and as yet, no intrahepatic recurrences or metastases have been observed in the robotic group. The mean postoperative stay was shorter with the traditional laparoscopic procedure (5.2 days) than with robotic (6.7 days) or open surgery (9.6 days). Conversions from traditional laparoscopic to open and hand-assisted laparoscopic resection occurred in 2 patients (10.0%) who underwent right hemihepatectomy and left hepatectomy, respectively.Conclusions: These preliminary results show that robotic-assisted laparoscopic anatomic hepatectomy is safe and feasible with a much lower complication and conversion rate than traditional laparoscopic hepatectomy or open resection. The robotic surgical system may broaden the indications for laparoscopic hepatactomy, and it enabled the surgeon to perform precise laparoscopic liver resection which required hylum dissection, hepatocaval dissection, endoscopic suturing, and microanastamosis. However, more long-term, evidence-based outcomes will be necessary to prove its efficacy, and further research on its cost-effectiveness is still required.