Southeastern Center for Digestive Disorder and Hepatopancreatobiliary Cancer, Advanced Minimally Invasive and Robotic Surgery, Florida Hospital Tampa, 3000 Medical Park Dr, Suite #500, Tampa, USA.
J Robot Surg. 2020 Feb;14(1):41-46. doi: 10.1007/s11701-019-00923-4. Epub 2019 Feb 1.
High body mass index (BMI) is associated with other multiple comorbidities such as non-alcoholic fatty liver disease, steatohepatitis, liver cirrhosis, and cardiopulmonary diseases, which can impact the perioperative outcomes following liver resection. We aimed to study the impact of BMI on perioperative outcomes after robotic liver resection. All the patients undergoing robotic liver resection between 2013 and 2017 were prospectively followed. The patients were divided into three groups (BMI < 25, BMI 25-35, BMI > 35 kg/m) for illustrative purposes. Demographic and perioperative outcome data were compared. Data are presented as median (mean ± SD). Thirty-eight patients underwent robotic hepatectomy, 73% were women, age was 58 (57 ± 17.6) years, and ASA class was 3 (3 ± 0.5). Indications for surgery were neoplastic lesions in 34 patients (89%), hemangioma in two patients (6%), fibrous mass in one patient (2.5%), and focal nodular hyperplasia in one patient (2.5%). 32% of the patients underwent right or left hemihepatectomy, 21% underwent sectionectomy, 5% underwent central hepatectomy and the reminder underwent non-anatomical liver resection. Operative time was 261 (254.6 ± 94.3) min. Estimated blood loss was 175 (276 ± 294.8) ml. Length of hospital stay was 3 (5 ± 4.9) days. By regression analysis of the three BMI groups, estimated blood loss, rate of postoperative complication, rate of conversion, need for transfusion, length of ICU stay, and length of hospital stay did not have a significant relationship with BMI. A total of five patients (13%) experience complications. Four patients had complications that were nonspecific to liver resection, including acute renal injury, respiratory failure, and enterocutaneous fistula. One patient had bile leak, treated with ERCP stenting. No mortality was seen in this study. Obesity should not dissuade surgeons from utilizing minimally invasive robotic approach for liver resection. Robotic technique is a safe and feasible in patients with high BMI. The impact of BMI on outcomes is insignificant.
高体重指数（BMI）与非酒精性脂肪肝、脂肪性肝炎、肝硬化和心肺疾病等多种合并症相关，这些合并症可能会影响肝切除术后的围手术期结果。我们旨在研究 BMI 对机器人辅助肝切除术后围手术期结果的影响。所有于 2013 年至 2017 年间接受机器人肝切除术的患者均进行前瞻性随访。患者按 BMI（<25kg/m、25-35kg/m、>35kg/m）分为三组。比较人口统计学和围手术期结果数据。数据以中位数（平均值±标准差）表示。38 例患者接受机器人肝切除术，其中 73%为女性，年龄为 58（57±17.6）岁，ASA 分级为 3（3±0.5）。手术指征为 34 例患者（89%）的肿瘤病变、2 例患者（6%）的肝血管瘤、1 例患者（2.5%）的纤维性肿块和 1 例患者（2.5%）的局灶性结节性增生。32%的患者行右或左半肝切除术，21%行肝段切除术，5%行中央肝切除术，其余患者行非解剖性肝切除术。手术时间为 261（254.6±94.3）min。估计出血量为 175（276±294.8）ml。住院时间为 3（5±4.9）天。通过对三组 BMI 的回归分析，估计出血量、术后并发症发生率、中转率、输血需求、ICU 住院时间和住院时间与 BMI 无显著相关性。共有 5 名患者（13%）发生并发症。4 名患者出现与肝切除术无关的并发症，包括急性肾损伤、呼吸衰竭和肠外瘘。1 名患者发生胆漏，行 ERCP 支架置入治疗。本研究无死亡病例。肥胖不应阻止外科医生采用微创机器人方法进行肝切除术。机器人技术在 BMI 较高的患者中是安全且可行的。BMI 对结果的影响并不显著。
