Robotic Liver Resection: A Case-Matched Comparison.
Robotic Liver Resection: A Case-Matched Comparison.
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DOI：
10.1007/s00268-016-3446-9
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发表时间：
2016-06
影响因子：
2.6
通讯作者：
Fong Y
中科院分区：
文献类型：
--
作者：
Kingham TP;Leung U;Kuk D;Gönen M;D'Angelica MI;Allen PJ;DeMatteo RP;Laudone VP;Jarnagin WR;Fong Y
近年来，越来越精密的工具使得更复杂的机器人手术成为可能。然而，机器人肝切除术仍处于起步阶段。我们的目的是研究机器人肝切除术的采用，并比较开放和机器人肝切除术的结果。将64名患者的机器人肝切除术经验与同一中心的64名开放式肝切除术患者的现代病例匹配系列进行比较。根据良性/恶性诊断和切除的节段数量进行匹配。回顾性获取患者资料。主要结果和指标为手术时间、估计出血量、转换率（机器人到开放）、Pringle手法的使用、单个非解剖楔形切除术率、切除边缘大小、并发症发生率（感染性、肝脏、肺部、心脏）、住院时间、ICU住院时间、再入院率和90天死亡率。2010-2014年共进行了64例机器人肝切除术。41%为节段性切除，34%为楔形切除。转化率为6%，90天死亡率为3%，发病率为11%。与64名接受开放式肝切除术的匹配患者（2004-2012）相比，中位OR时间更短（p=0.02），中位估计失血量更低（p<0.001），中位住院时间更短（p<0.001）。11例机器人病例是在第2、7和8节段孤立切除肿瘤。机器人肝切除术安全有效。越来越多的中心的经验将允许定义哪些肝切除术可以进行机器人，并将使结果优化，并对每种方法的经济成本进行前瞻性检查。
In recent years, increasingly sophisticated tools have allowed for more complex robotic surgery. Robotic hepatectomy, however, is still in its infancy. Our goals were to examine the adoption of robotic hepatectomy and to compare outcomes between open and robotic liver resections. The robotic hepatectomy experience of 64 patients was compared to a modern case-matched series of 64 open hepatectomy patients at the same center. Matching was according to benign/malignant diagnosis and number of segments resected. Patient data were obtained retrospectively. The main outcomes and measures were operative time, estimated blood loss, conversion rate (robotic to open), Pringle maneuver use, single non-anatomic wedge resection rate, resection margin size, complication rates (infectious, hepatic, pulmonary, cardiac), hospital stay length, ICU stay length, readmission rate, and 90-day mortality rate. Sixty-four robotic hepatectomies were performed in 2010–2014. Forty-one percent were segmental and 34% were wedge resections. There was a 6% conversion rate, a 3% 90-day mortality rate, and an 11% morbidity rate. Compared to 64 matched patients who underwent open hepatectomy (2004–2012), there was a shorter median OR time (p=0.02), lower median estimated blood loss (p<0.001), and shorter median hospital stay (p<0.001). Eleven of the robotic cases were isolated resections of tumors in segments 2, 7, and 8.. Robotic hepatectomy is safe and effective. Increasing experience in more centers will allow definition of which hepatectomies can be performed robotically, and will enable optimization of outcomes and prospective examination of the economic cost of each approach.