Department of Surgery, Yonsei University Health System, 250 Seongsanno, Seodaemoon-gu, Seoul 120-752, Korea.
Surg Endosc. 2012 Aug;26(8):2247-58. doi: 10.1007/s00464-012-2168-9. Epub 2012 Feb 4.
Robotic surgery can enhance a surgeon's laparoscopic skills through a magnified three-dimensional view and instruments with seven degrees of freedom compared to conventional laparoscopy.
This study reviewed a single surgeon's experience of robotic liver resections in 30 consecutive patients, focusing on major hepatectomy. Clinicopathological characteristics and perioperative and short-term outcomes were analyzed.
The mean age of the patients was 52.4 years and 14 were male. There were 21 malignant tumors and 9 benign lesions. There were 6 right hepatectomies, 14 left hepatectomies, 4 left lateral sectionectomies, 2 segmentectomies, and 4 wedge resections. The average operating time for the right and left hepatectomies was 724 min (range 648-812) and 518 min (range 315-763), respectively. The average estimated blood loss in the right and left hepatectomies was 629 ml (range 100-1500) and 328 ml (range 150-900), respectively. Four patients (14.8%) received perioperative transfusion. There were two conversions to open surgery (one right hepatectomy and one left hepatectomy). The overall complication rate was 43.3% (grade I, 5; grade II, 2; grade III, 6; grade IV, 0) and 40% in 20 patients who underwent major hepatectomy. Among the six (20.0%) grade III complications, a liver resection-related complication (bile leakage) occurred in two patients. The mean length of hospital stay was 11.7 days (range 5-46). There was no recurrence in the 13 patients with hepatocellular carcinoma during the median follow-up of 11 months (range 5-29).
From our experience, robotic liver resection seems to be a feasible and safe procedure, even for major hepatectomy. Robotic surgery can be considered a new advanced option for minimally invasive liver surgery.
与传统腹腔镜相比，机器人手术通过放大的三维视图和具有 7 个自由度的器械，可以增强外科医生的腹腔镜技能。
本研究回顾了一位外科医生在 30 例连续患者中进行的机器人肝切除术经验，重点是大肝切除术。分析了临床病理特征以及围手术期和短期结果。
患者的平均年龄为 52.4 岁，14 例为男性。有 21 例恶性肿瘤和 9 例良性病变。有 6 例右半肝切除术、14 例左半肝切除术、4 例左外侧段切除术、2 例肝段切除术和 4 例楔形切除术。右半肝和左半肝切除术的平均手术时间分别为 724 分钟（范围 648-812）和 518 分钟（范围 315-763）。右半肝和左半肝切除术的平均估计出血量分别为 629 毫升（范围 100-1500）和 328 毫升（范围 150-900）。有 4 例患者（14.8%）接受了围手术期输血。有 2 例转为开腹手术（1 例右半肝切除术，1 例左半肝切除术）。总体并发症发生率为 43.3%（1 级 5 例，2 级 2 例，3 级 6 例，4 级 0 例），20 例大肝切除术患者的并发症发生率为 40%。在 6 例（20.0%）3 级并发症中，有 2 例与肝切除术相关的并发症（胆漏）。平均住院时间为 11.7 天（范围 5-46）。在中位随访 11 个月（范围 5-29）期间，13 例肝细胞癌患者无复发。
根据我们的经验，机器人肝切除术似乎是一种可行且安全的手术方法，即使是大肝切除术也是如此。机器人手术可以被认为是微创肝手术的一种新的先进选择。
