Coletta Diego, Ossola Paolo, Parrino Chiara, Oddi Andrea, D'Annibale Marco, Perri Pasquale, De Peppo Valerio, Grazi Gian Luca
Division of Hepatopancreatobiliary Surgery, Department of Surgery, IRCCS- Regina Elena National Cancer Institute, Rome, Italy.
Emergency Department-Division of Emergency and Trauma Surgery, Department of General Surgery, Umberto I University Hospital, Sapienza University of Rome, Rome, Italy.
J Laparoendosc Adv Surg Tech A. 2020 Nov;30(11):1177-1182. doi: 10.1089/lap.2020.0119. Epub 2020 Apr 28.
Recently, the minimally invasive surgical approach has been available for performing liver resections (LRs) with laparoscopic and robotic techniques. The robotic approach for LRs seems to overcome several laparoscopic limitations, which is a valid alternative when performed in high volume and specialized centers. Laparoscopic difficulty score systems (DSSs) should serve to guide the surgeon's choice in the best surgical approach to adopt for every single patient, giving the possibility to switch to the open approach when needed. To this day, no specific robotic difficulty scores exist. The aim of our study was to verify the feasibility of applying these scores and related updates on robotic LRs performed in our Institute. Out of a total of 683 LRs performed from June 2010 to July 2019, 60 were performed through using a mini invasive approach and of these 18 were performed robotically. The Ban DSS and subsequently the modified Iwate DSS were applied to our cases. Based on our findings, applying the DSS we divided our series into two groups: a low difficulty level group (1-3) made up of 5 patients, and an intermediate difficulty level group (4-6) consisting of 13 patients. Average Ban DSS and subsequently updated score system results were 4.6 ± 1.5 points (range 2-6) for both scores. Difficulties were encountered in applying the score when simultaneous multiple wedge resections were performed. The laparoscopic DSS is applicable to robotic LRs with some limitations due to the peculiarity of the two different minimally invasive approaches. A specific robotic difficulty rating score could be necessary to include these elements.
最近，微创外科手术方法已可用于通过腹腔镜和机器人技术进行肝切除术（LRs）。机器人辅助肝切除术似乎克服了一些腹腔镜手术的局限性，在大量开展且专业的中心进行时，是一种有效的替代方法。腹腔镜手术难度评分系统（DSSs）应有助于指导外科医生为每个患者选择最佳的手术方法，并在需要时可转为开放手术。时至今日，尚无特定的机器人手术难度评分。我们研究的目的是验证在我们研究所进行的机器人辅助肝切除术中应用这些评分及相关更新的可行性。在2010年6月至2019年7月期间进行的总共683例肝切除术中，有60例采用微创方法进行，其中18例为机器人辅助手术。将Ban DSS以及随后改良的岩手DSS应用于我们的病例。根据我们的研究结果，应用DSS将我们的病例系列分为两组：低难度组（1 - 3分），由5例患者组成；中等难度组（4 - 6分），由13例患者组成。两种评分的平均Ban DSS及随后更新的评分系统结果均为4.6±1.5分（范围2 - 6分）。在进行同步多楔形切除时应用评分遇到了困难。由于两种不同微创方法的特殊性，腹腔镜DSS在应用于机器人辅助肝切除术时存在一些局限性。可能需要一个特定的机器人手术难度评级评分来纳入这些因素。
