The Second Department of Hepatopancreatobiliary Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China.
Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
Updates Surg. 2021 Jun;73(3):1007-1014. doi: 10.1007/s13304-020-00895-3. Epub 2020 Oct 8.
Laparoscopic hepatectomy in the posterosuperior hepatic region is technically challenging and demanding. However, minimally invasive procedures carried out using the Da Vinci robot provide potential advantages in complex hepatectomy. This study reported the experience of a single center on robotic hepatectomy in the posterosuperior hepatic region.
This retrospective study evaluated the general characteristics and perioperative outcomes of consecutive patients who underwent robotic hepatectomy in the posterosuperior hepatic region at our center from March 2015 to January 2020.
For 100 patients who were included into this study, 53 underwent anatomical segmentectomy or subsegmentectomy and 47 non-anatomical partial hepatectomy. There was no conversion to laparotomy. The R0 resection rate was 100%. The following perioperative outcomes were compared between patients who underwent anatomical segmentectomy/subsegmentectomy versus those who underwent non-anatomical partial hepatectomy: operation times of 160 versus 126 min, intraoperative blood losses of 100 versus 50 ml, intraoperative blood transfusion rates of 7.54% versus 4.26%, postoperative lengths of hospital stay of 5 versus 4 days, Clavien-Dindo Grade I-II complications rates of 15.09% versus 19.15%, Grade III-V complications rates of 3.77% versus 0%, bile leakage rates of 4% versus 7% and pleural effusion rates of also 4% versus 7%, respectively.
The results indicated the safety and feasibility of robotic anatomical and non-anatomical liver resections in the posterosuperior hepatic region. The robotic transabdominal approach is an option for hepatectomy in the posterosuperior hepatic region.
后上肝区腹腔镜肝切除术技术上具有挑战性和难度。然而，达芬奇机器人辅助的微创手术在复杂肝切除术中具有潜在优势。本研究报告了单中心达芬奇机器人辅助后上肝区肝切除术的经验。
本回顾性研究评估了 2015 年 3 月至 2020 年 1 月期间在我院行达芬奇机器人辅助后上肝区肝切除术的连续患者的一般特征和围手术期结果。
本研究共纳入 100 例患者，53 例行解剖性肝段或亚段切除术，47 例行非解剖性肝部分切除术。无中转开腹。R0 切除率为 100%。比较行解剖性肝段/亚段切除术与非解剖性肝部分切除术患者的围手术期结果：手术时间分别为 160 分钟与 126 分钟，术中出血量分别为 100 毫升与 50 毫升，术中输血率分别为 7.54%与 4.26%，术后住院时间分别为 5 天与 4 天，Clavien-Dindo Ⅰ-Ⅱ级并发症发生率分别为 15.09%与 19.15%，Ⅲ-Ⅴ级并发症发生率分别为 3.77%与 0%，胆漏发生率分别为 4%与 7%，胸腔积液发生率分别为 4%与 7%。
结果表明达芬奇机器人辅助解剖性和非解剖性肝切除在后上肝区是安全可行的。机器人经腹腔入路是后上肝区肝切除术的一种选择。
