Gravetz Aviad, Sucandy Iswanto, Wilfong Chandler, Patel Nirrita, Spence Janelle, Ross Sharona, Rosemurgy Alexander
Am Surg. 2019 Jan 1;85(1):115-119.
Robotic liver resection is being introduced with its potential to overcome limitations of conventional laparoscopy. This study was undertaken to document early experience and learning curve of robotic liver resection in our institution. All patients undergoing liver resection between 2013 and 2017 were prospectively followed. Patients were divided into three consecutive tertiles (cohort I-III). Thirty-three patients underwent robotic liver resection within the study period. Twenty-four per cent of patients underwent formal right or left hemihepatectomy, 21 per cent underwent sectionectomy, 6 per cent underwent central hepatectomy, and the remainder underwent nonanatomical liver resection. Formal hemihepatectomy and right posterosuperior segment resection were undertaken in two patients in cohort I, four patients in cohort II, and four patients in cohort III. Two cases were converted to "open" operation. Operative time was 172 (194.5 ± 65.1) minutes in cohort I, 222 (247.8 ± 109.8) minutes in cohort II, and 280 (302.5 ± 84.9) minutes in cohort III, reflecting increasing degree of technical complexity. Estimated blood loss decreased significantly throughout the cohorts, being 400 mL, 200 mL, and 100 mL in cohorts I to III, respectively. Major intraoperative complications were not seen. Three patients experienced postoperative complications, resulting in a single mortality. Length of hospital stay was three days, with two patients being readmitted within 30 days. Robotic technique for liver resection is feasible and safe. It offers good short-term clinical outcomes, including for patients who require major liver resection. As the proficiency developed, a notable improvement in technically ability to undertake more complex resections with decreasing blood loss and minimal morbidity was seen.
机器人肝切除术正在被引入，它有潜力克服传统腹腔镜手术的局限性。本研究旨在记录我们机构机器人肝切除术的早期经验和学习曲线。对2013年至2017年间所有接受肝切除术的患者进行前瞻性随访。患者被连续分为三个三分位数组（队列I - III）。在研究期间，33例患者接受了机器人肝切除术。24%的患者接受了正规的右半肝或左半肝切除术，21%接受了肝段切除术，6%接受了中央肝切除术，其余患者接受了非解剖性肝切除术。队列I中有2例患者、队列II中有4例患者、队列III中有4例患者接受了正规半肝切除术和右后上肝段切除术。2例转为“开放”手术。队列I的手术时间为172（194.5±65.1）分钟，队列II为222（247.8±109.8）分钟，队列III为280（302.5±84.9）分钟，反映出技术复杂性程度不断增加。整个队列中估计失血量显著减少，队列I至III分别为400 mL、200 mL和100 mL。未观察到重大术中并发症。3例患者出现术后并发症，导致1例死亡。住院时间为3天，2例患者在30天内再次入院。机器人肝切除技术是可行且安全的。它提供了良好的短期临床结果，包括对于需要进行大型肝切除术的患者。随着技术熟练程度的提高，在进行更复杂切除术时技术能力有显著提高，失血量减少且发病率最低。
