Wu Chao-Ying, Chen Po-Da, Lee Chih-Yuan, Liang Jin-Tung, Wu Yao-Ming
Department of Surgery, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan.
Department of Surgery, National Taiwan University Hospital, College of Medicine, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan.
J Robot Surg. 2019 Apr;13(2):231-237. doi: 10.1007/s11701-018-0842-1. Epub 2018 Jul 11.
Despite the popularity of minimally invasive surgery (MIS) for hepatectomy, limitations in the approach of the right posterior section of the liver remain. Although skills and approach techniques have been developed for hepatectomy of lesions in the posterior segments of the liver, most are performed laparoscopically and are limited to few experienced hands using rigid laparoscopic instruments. In this study, we tried a different approach area via the aid of a flexible robotic system. Since 2012, we have successfully completed more than 200 robotic hepatectomy procedures in our institution. Two different patient settings have been applied for right posterior segment lesions, including supine position as general setting in early cases and left semi-lateral decubitus setting in our later cases. The demographic data and perioperative outcomes between the two groups were analyzed in regard to different positioning. A total of 25 patients with right posterior segment lesions underwent robotic-assisted resection, 13 were placed in supine position and 12 in left semi-lateral position. The left semi-lateral group had significantly shorter operation time (306.0 versus 416.8 min, p = 0.023), less blood loss (203.9 versus 1092.3 mL, p = 0.030), and lower transfusion rates (0 versus 46.2%, p = 0.015). We described an evolutionary technique for robotic right posterior segmentectomies with the patient placed in left semi-lateral position. This method can be applied for most patients easily and is demonstrated as a safe and feasible approach in selected patients owing to its ability to overcome the difficulty of MIS hepatectomy for right posterior lesions.
尽管微创肝切除术很受欢迎，但肝脏右后叶的手术入路仍存在局限性。虽然已经开发出了针对肝后段病变肝切除术的技术和入路方法，但大多数是通过腹腔镜进行的，并且仅限于少数使用刚性腹腔镜器械的有经验的医生。在本研究中，我们借助柔性机器人系统尝试了不同的入路区域。自2012年以来，我们在本机构已成功完成了200多例机器人肝切除手术。对于右后段病变采用了两种不同的患者体位设置，早期病例的一般体位为仰卧位，后期病例为左侧半卧位。针对不同体位对两组患者的人口统计学数据和围手术期结果进行了分析。共有25例右后段病变患者接受了机器人辅助切除术，13例采用仰卧位，12例采用左侧半卧位。左侧半卧位组的手术时间明显更短（306.0分钟对416.8分钟，p = 0.023），失血量更少（203.9毫升对1092.3毫升，p = 0.030），输血率更低（0对46.2%，p = 0.015）。我们描述了一种将患者置于左侧半卧位的机器人右后段切除术的改进技术。该方法可轻松应用于大多数患者，并且由于其能够克服右后段病变微创肝切除术的困难，在选定患者中被证明是一种安全可行的方法。
