Department of Surgery, Prince of Wales Hospital, 30-32, Ngan Shing Street, Shatin, NT, Hong Kong.
Surg Endosc. 2021 May;35(5):2316-2323. doi: 10.1007/s00464-020-07645-x. Epub 2020 Nov 13.
BACKGROUND: Minimally invasive approach has been increasingly applied in liver resection. However, laparoscopic major hepatectomy is technically demanding and is practiced only in expert centers around the world. Conversely, use of robot may help to overcome the difficulty and facilitate major hepatectomy. METHODS: Between September 2010 and March 2019, 151 patients received robotic hepatectomy for various indications in our center. 36 patients received robotic hemihepatectomy: 26 left hepatectomy and 10 right hepatectomy. During the same period, 737 patients received open hepatectomy and out of these, 173 patients received open hemihepatectomy. A propensity score-matched analysis was performed in a 1:1 ratio. RESULTS: After matching, there were 36 patients each in the robotic and open group. The two groups were comparable in demographic data, type of hemihepatectomy, underlying pathology, size of tumor, and background cirrhosis. Conversion was needed in 3 patients (8.3%) in the robotic group. There was no operative mortality. The operative blood loss and resection margin were similar. Though not significantly different, there was a higher rate of complications in the robotic group (36.1% vs. 22.2%) and this difference was mostly driven by higher intra-abdominal collection (16.7% vs. 5.6%) and bile leak (5.6% vs. 2.8%). Operative time was significantly longer (400.8 ± 136.1 min vs 255.4 ± 74.4 min, P < 0.001) but the postoperative hospital stay was significantly shorter (median 5 days vs 6.5 days, P = 0.040) in the robotic group. When right and left hepatectomy were analyzed separately, the advantage of shorter hospital stay remained in left but not right hepatectomy. For patients with hepatocellular carcinoma, there was no difference between the two groups in 5-year overall and disease-free survival. CONCLUSION: Compared with the open approach, robotic hemihepatectomy has longer operation time but shorter hospital stay. Thus, use of robot is feasible and effective in hemihepatectomy with the benefit of shorter hospital stay.
背景：微创方法已越来越多地应用于肝切除术。然而，腹腔镜肝切除术技术要求高，仅在世界范围内的专家中心开展。相比之下，机器人的使用可能有助于克服困难并促进肝切除术的开展。
方法：2010 年 9 月至 2019 年 3 月，我院中心对 151 例不同适应证的患者实施了机器人肝切除术。36 例患者接受了机器人半肝切除术：26 例左半肝切除术和 10 例右半肝切除术。同期，737 例患者接受了开腹肝切除术，其中 173 例接受了开腹半肝切除术。采用 1:1 比例进行倾向评分匹配分析。
结果：匹配后，机器人组和开腹组各有 36 例患者。两组患者的人口统计学数据、半肝切除术类型、基础病理学、肿瘤大小和背景肝硬化均具有可比性。机器人组有 3 例（8.3%）患者需要中转开腹。两组均无手术死亡病例。术中出血量和切缘均相似。虽然无显著差异，但机器人组的并发症发生率较高（36.1% vs. 22.2%），这主要是由于更高的腹腔积（16.7% vs. 5.6%）和胆漏（5.6% vs. 2.8%）所致。机器人组的手术时间明显较长（400.8 ± 136.1 分钟 vs. 255.4 ± 74.4 分钟，P < 0.001），但术后住院时间明显较短（中位数 5 天 vs. 6.5 天，P = 0.040）。当分别分析左右半肝切除术时，住院时间的优势仅在左半肝切除术时存在，而在右半肝切除术时则不存在。对于肝细胞癌患者，两组的 5 年总生存率和无病生存率无差异。
结论：与开腹手术相比，机器人半肝切除术的手术时间较长，但住院时间较短。因此，机器人在半肝切除术中是可行且有效的，其优势在于术后住院时间较短。
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