General and Robotic Surgery Department, San Giovanni Battista Hospital, Foligno, Perugia, Italy.
San Donato Hospital, General and Robotic Surgery Unit, Arezzo, Italy.
Updates Surg. 2021 Jun;73(3):1015-1022. doi: 10.1007/s13304-021-01009-3. Epub 2021 Apr 8.
Different strategies may be adopted in patients with synchronous colorectal liver metastases (LM). The role of laparoscopy has been investigated to define the benefits of minimally invasive surgery in a single-stage operation. In our study, we report our experience of 28 Minimally Invasive Robotic-Assisted combined Colorectal and Liver Excision Surgery (MIRACLES). From October 2012 to December 2019, 135 Robotic liver resections and 218 Robotic Colorectal resections were performed in our center. Twenty-eight patients underwent MIRACLES resection with 37 nodules removed. Fifty-two lesions in 28 patients were resected in minimally invasive robot-assisted surgery. Eighteen lesions were located in postero-superior liver segments (eight in segment VII, two in segment VIII, eight in segment IVa). Nine right colectomies, seven left colectomies, ten anterior rectal resections, one Hartmann and one MILES procedures were performed. The median surgical time of MIRACLES procedures was 332 min. Two conversions to open approach were necessary. Four major complications (> III) were observed. No postoperative mortality was recorded. The median hospital stay was 8 days. The median overall survival was 27.5 months. The MIRACLES approach is feasible and safe for colorectal resection and hepatic nodules located in all segments, with a low rate of postoperative complications. Surgical technique is demanding and should be reserved, presently, to tertiary centers.
对于同时患有结直肠肝转移（LM）的患者，可能会采用不同的策略。腹腔镜的作用已经被研究，以确定在单阶段手术中微创手术的优势。在我们的研究中，我们报告了 28 例微创机器人辅助结直肠和肝切除术（MIRACLES）的经验。从 2012 年 10 月至 2019 年 12 月，我们中心进行了 135 例机器人肝切除术和 218 例机器人结直肠切除术。28 例患者接受了 MIRACLES 切除术，切除了 37 个结节。在 28 例患者中，52 个病灶在微创机器人辅助手术中被切除。18 个病灶位于肝后上叶（7 个位于 VII 段，2 个位于 VIII 段，8 个位于 IVa 段）。进行了 9 例右半结肠切除术、7 例左半结肠切除术、10 例前直肠切除术、1 例 Hartmann 手术和 1 例 MILES 手术。MIRACLES 手术的中位手术时间为 332 分钟。需要转为开放手术 2 例。观察到 4 例（>III 级）主要并发症。无术后死亡病例。中位住院时间为 8 天。中位总生存时间为 27.5 个月。MIRACLES 方法对于位于所有节段的结直肠切除和肝结节是可行且安全的，术后并发症发生率低。手术技术要求较高，目前应保留在三级中心。
