Felli Emanuele, Santoro Roberto, Colasanti Marco, Vennarecci Giovanni, Lepiane Pasquale, Ettorre Giuseppe M
Digestive and Transplant Liver Surgery Unit, S.Camillo Hospital, Piazza Carlo Forlanini, 1 00151, Rome, Italy,
Updates Surg. 2015 Mar;67(1):27-32. doi: 10.1007/s13304-015-0285-4. Epub 2015 Mar 8.
Minimally invasive liver surgery is performed with increasing frequency by hepatic surgeons. Laparoscopy was the first approach to be used and it is currently safely feasible in selected patients by experienced surgeons. Minor and major laparoscopic hepatectomies are now performed as a routine procedure in tertiary referral centers, with increasing evidence of long-term results comparable to traditional surgery together with the advantages of a minimally invasive approach. Robotic surgery, first developed for military purposes, showed to overcome some of the limits of laparoscopy, with an improved visual magnification, a 3-dimensional view and enhanced dexterity with better movement control. This allows an easier approach for resections in the posterior segments and for lesions close to major vessels. We present our preliminary experience of 20 consecutive robotic liver resection. Indications were colo-rectal liver metastasis (n = 7), hepatocellular carcinoma (n = 6), liver hemangioma (n = 2), biliary cystoadenoma (n = 2), breast cancer liver metastasis (n = 1), lung cancer liver metastasis (n = 1), symptomatic left liver lithiasis (n = 1). No conversion to laparotomy have been made and no hepatic pedicle clamping has been performed. The median duration of surgery was 141 min. There was no mortality, global morbidity was 10%. Median tumor size was 36 mm. Median post-operative length of stay was 5.7 days. Robotic surgery can be safely performed by experienced hepatic surgeons, resections of lesions in the posterior segments and close to the major vessels seem to be the best indication. Further studies are needed to clarify the exact role of robotics in liver surgery.
肝脏外科医生进行微创肝脏手术的频率越来越高。腹腔镜检查是最早使用的方法，目前经验丰富的外科医生在选定的患者中进行该操作是安全可行的。现在，在三级转诊中心，小型和大型腹腔镜肝切除术已成为常规手术，越来越多的证据表明其长期效果与传统手术相当，同时具有微创方法的优势。机器人手术最初是为军事目的而开发的，已显示出能克服腹腔镜检查的一些局限性，具有更好的视觉放大效果、三维视野以及通过更好的运动控制增强的灵活性。这使得更容易接近肝后段的切除术以及靠近主要血管的病变。我们展示了连续20例机器人肝脏切除术的初步经验。适应证包括结直肠癌肝转移（n = 7）、肝细胞癌（n = 6）、肝血管瘤（n = 2）、胆管囊腺瘤（n = 2）、乳腺癌肝转移（n = 1）、肺癌肝转移（n = 1）、有症状的左肝结石（n = 1）。未进行开腹手术转换，也未进行肝蒂阻断。手术中位持续时间为141分钟。无死亡病例，总体发病率为10%中位肿瘤大小为36毫米。术后中位住院时间为5.7天。经验丰富的肝脏外科医生可以安全地进行机器人手术，肝后段和靠近主要血管的病变切除术似乎是最佳适应证。需要进一步研究以阐明机器人技术在肝脏手术中的确切作用。
