Giulianotti Pier Cristoforo, Sbrana Fabio, Coratti Andrea, Bianco Francesco Maria, Addeo Pietro, Buchs Nicolas Christian, Ayloo Subhashini M, Benedetti Enrico
Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA.
Arch Surg. 2011 Jul;146(7):844-50. doi: 10.1001/archsurg.2011.145.
Robotic surgery for performance of right hepatectomy is safe and effective.
Case series from 2 medical institutions.
University of Illinois at Chicago and Misericordia Hospital, Grosseto, Italy.
Twenty-four patients underwent right hepatectomy between March 1, 2005, and January 31, 2010, using a robotic surgical system.
Intraoperative blood loss, operative time, morbidity, mortality, and long-term oncologic follow-up.
The procedure was converted to open surgery in 1 patient (4.2%). The overall mean (SD) operative time was 337 (65) minutes (range, 240-480 minutes), and the mean (SD) intraoperative blood loss was 457 (401) mL (range, 100-2000 mL). Three patients (12.5%) underwent blood transfusion. There were no perioperative deaths and no reoperations. Six patients (25.0%) experienced postoperative morbidity, including transitory liver failure in 2 patients and pleural effusion, bile leak, fluid collection, and deep venous thrombosis in 1 patient each. The patients' diagnoses included colorectal liver metastases (n = 11), noncolorectal liver metastases (n = 4), hemangioma (n = 4), adenoma (n = 2), hepatocellular carcinoma (n = 1), hepatoblastoma (n = 1), and biliary amartoma (n = 1). At a mean follow-up duration of 34 months, no port site metastases were observed in patients with malignant pathologic findings.
The zero mortality and acceptable morbidity of our series indicate that in experienced hands, robotic right hepatectomy is feasible and safe. Robotic surgery offers a new technical option for minimally invasive major hepatic resections. Long-term results seem to confirm oncologic effectiveness of the procedure.
机器人辅助右半肝切除术安全有效。
来自两家医疗机构的病例系列研究。
美国伊利诺伊大学芝加哥分校和意大利格罗塞托米塞里科迪亚医院。
2005年3月1日至2010年1月31日期间，24例患者使用机器人手术系统接受了右半肝切除术。
术中失血、手术时间、发病率、死亡率及长期肿瘤学随访情况。
1例患者（4.2%）手术转为开腹手术。总体平均（标准差）手术时间为337（65）分钟（范围240 - 480分钟），平均（标准差）术中失血量为457（401）毫升（范围100 - 2000毫升）。3例患者（12.5%）接受了输血。围手术期无死亡病例，也无再次手术病例。6例患者（25.0%）出现术后并发症，包括2例短暂性肝衰竭，1例患者分别出现胸腔积液、胆漏、积液和深静脉血栓形成。患者的诊断包括结直肠癌肝转移（n = 11）、非结直肠癌肝转移（n = 4）、肝血管瘤（n = 4）、腺瘤（n = 2）、肝细胞癌（n = 1）、肝母细胞瘤（n = 1）和胆管错构瘤（n = 1）。平均随访34个月，恶性病理结果患者未观察到切口部位转移。
本系列研究零死亡率和可接受的发病率表明，在经验丰富的医生手中，机器人辅助右半肝切除术是可行且安全的。机器人手术为微创性大肝切除术提供了一种新的技术选择。长期结果似乎证实了该手术在肿瘤学方面的有效性。
