Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University Hospital of Modena "Policlinico", University of Modena and Reggio Emilia, Modena, Italy.
Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University Hospital of Modena "Policlinico", University of Modena and Reggio Emilia, Modena, Italy; Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital, Singapore.
Eur J Surg Oncol. 2023 Nov;49(11):107002. doi: 10.1016/j.ejso.2023.107002. Epub 2023 Aug 1.
Implementation of minimally invasive surgical approaches for perihilar cholangiocarcinoma (pCCA) has been relatively slow compared to other indications. This is due to the complexity of the disease and the need of advanced skills for the reconstructive phase. The robot may contribute to close the gap between open and minimally invasive surgery in patients with Klastkin tumors.
We report details of our experience with robotic approach in patients affected by pCCA. In particular selection criteria, ERAS management, technical tips and robotic setup are discussed. Finally, results from our cohort are reported. A video clip of a patient that underwent left hepatectomy with en-bloc caudatectomy and portal vein resection at the confluence with end-to-end reconstruction for a pCCA 3-b according to Bismuth-Corlette classification with full robotic approach is enclosed.
Fourteen patients underwent robotic resection of pCCA over the three-year interval with a median follow-up interval of 18.7 months. The pre-operative Bismuth-Corlette classification was 1 for two patients (14.2%) and 2 for one patient (7.1%), 3-a for three (21.4%) patients, 3-b for four (28.6%) patients and 4 for four (28.6%) patients. Median estimated blood loss was 150 ml (range 50-800 ml) and median operative time was 490 min (range 390-750 min). The median length of hospital stay after the index operation was 6 days (range 3-91). Final histology revealed a median of 19 (range 11-40) lymph nodes retrieved, with 92.9% R0 resections. 90-days mortality was nihil and 3-year survival exceeds 50%.
With adequate preparation, outcomes of robotic approach to pCCA can be safe and in line with the current international benchmark outcomes, as showed in this study, when performed in expert high volume centers for complex major hepatectomy and robotic HPB.
与其他适应证相比，微创外科方法在肝门周围胆管癌（pCCA）中的应用相对缓慢。这是由于疾病的复杂性以及对重建阶段的高级技能的需求。机器人可能有助于缩小开放手术和微创外科之间的差距，使 Klastkin 肿瘤患者受益。
我们报告了在患有 pCCA 的患者中使用机器人方法的详细经验。特别是讨论了选择标准、ERAS 管理、技术技巧和机器人设置。最后，报告了我们队列的结果。一个视频剪辑展示了一名患者，该患者在三年的时间间隔内接受了机器人辅助左半肝切除术，包括尾状叶切除术和门静脉切除，在汇合处进行端端吻合重建，根据 Bismuth-Corlette 分类，pCCA 为 3-b 型，采用全机器人方法。
在三年的时间间隔内，有 14 名患者接受了机器人辅助 pCCA 切除术，中位随访间隔为 18.7 个月。术前 Bismuth-Corlette 分类为 1 型 2 例（14.2%），1 型 1 例（7.1%），3-a 型 3 例（21.4%），3-b 型 4 例（28.6%），4 型 4 例（28.6%）。中位估计出血量为 150ml（范围 50-800ml），中位手术时间为 490min（范围 390-750min）。索引手术后的中位住院时间为 6 天（范围 3-91 天）。最终组织学显示中位 19 个（范围 11-40 个）淋巴结被检出，92.9%的 R0 切除率。90 天死亡率为零，3 年生存率超过 50%。
通过充分的准备，在专家高容量中心进行复杂的大型肝切除术和机器人 HPB 时，pCCA 的机器人方法的结果可以是安全的，并且与当前的国际基准结果一致，正如本研究所示。
