Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Ann Surg Oncol. 2022 Dec;29(13):8455. doi: 10.1245/s10434-022-12493-1. Epub 2022 Sep 16.
Advantages of minimally invasive compared with open hepatobiliary surgery include quicker functional recovery, decreased postoperative length of stay, and decreased postoperative opioid use. As more complex operations are approached in minimally invasive fashion, it is imperative to maintain safety and excellent oncologic outcomes.
In this video, we demonstrate the key principles in performing a safe robotic extended right hepatectomy for colorectal liver metastasis following sound oncologic principles.
Key preoperative considerations include (1) early referral to a hepatobiliary surgeon, (2) careful review of cross-sectional imaging to identify the relationship of tumors to major vasculature and any aberrant vascular anatomy, and (3) liver volumetry for every right hepatectomy to determine the need for future liver remnant volume augmentation. Key intraoperative techniques include (1) liberal use of ultrasound before and during transection to determine the relationship of major vasculature to tumor to preserve liver parenchyma without compromising tumor margins, (2) external retraction with vessel loops placed on either side of the transection line as stay sutures to facilitate parenchymal transection, and (3) a crush clamp technique to safely identify and control crossing vessels while dividing liver parenchyma.
With proper preoperative planning and intraoperative use of these techniques, the benefits of a minimally invasive approach can be achieved while maintaining excellence in surgical quality and safety.
与开腹肝胆手术相比，微创的优势包括更快的功能恢复、术后住院时间缩短和术后阿片类药物使用减少。随着越来越多的复杂手术采用微创方式进行，保持安全性和卓越的肿瘤学结果至关重要。
在这段视频中，我们展示了在遵循肿瘤学原则的前提下，进行安全的机器人右半肝扩大切除术治疗结直肠癌肝转移的关键原则。
术前需要考虑的关键因素包括：（1）尽早向肝胆外科医生转诊；（2）仔细审查横断面成像，以确定肿瘤与主要血管和任何异常血管解剖结构的关系；（3）对每一次右半肝切除术进行肝体积测量，以确定是否需要未来的肝剩余体积增加。术中关键技术包括：（1）在横断前和横断期间广泛使用超声，以确定主要血管与肿瘤的关系，在不损害肿瘤边缘的情况下保留肝实质；（2）在横断线的两侧放置血管套环作为牵引缝线，以利于肝实质横断；（3）使用压榨夹技术安全地识别和控制穿过肝实质的交叉血管。
通过适当的术前规划和术中应用这些技术，可以实现微创方法的优势，同时保持手术质量和安全性的卓越。
