Division of Hepatobiliary & Pancreas Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, 1025 Morehead Medical Dr. Suite 600, Charlotte, NC, 28204, USA.
Carolinas Center for Surgical Outcomes Science, Atrium Health, Charlotte, NC, USA.
Surg Endosc. 2024 Feb;38(2):902-907. doi: 10.1007/s00464-023-10459-2. Epub 2023 Oct 16.
Adoption of robotic liver resections has been gradually increasing throughout the HPB surgical community over the past decade. Currently there is limited literature which demonstrates a significant benefit of robotic surgery for major hepatectomies over open or laparoscopic. As one of the first centers to develop a robotic HPB program, we have experienced improved outcomes over time with increasing utilization of robotics. Herein, we present our 10-year experience and outcomes for major robotic liver resections.
From 2012 to 2022, 361 robotic liver procedures were performed, including 100 major hepatectomies. A retrospective data review of the electronic medical record was performed evaluating outcomes after robotic major hepatectomy. Outcomes for the first 50 cases (Group A) and second 50 cases (Group B) were compared to identify any improvements in practice. Demographic and clinical outcome variables were analyzed. Data were assessed for normality, and Wilcoxon rank-sum, χ tests, and a logistic regression model were performed appropriate for the data. Stata v.17 was utilized, and significance was set as p < .05.
There was no difference in median operative time (258 vs 256 min), EBL (500 vs 500 mL), median LOS (5 vs 3.5 days), 90-day readmission (14% vs 24%), major complications (14% vs 20%), and 90-day mortality (6% vs 4%) between early and late cases, respectively. ICU admissions and conversion rates were significantly lower in group B (14.0% vs 48.0%), while expert level difficulty indices were higher (82% vs 58%).
Development of a robotic liver program with good outcomes is feasible over time. Our data suggest that our institutional learning curve for robotic major hepatectomy plateaued at approximately 50 cases.
在过去的十年中，机器人肝切除术在肝胆外科学领域逐渐得到普及。目前，关于机器人手术在大型肝切除术中比开放或腹腔镜手术具有显著优势的文献有限。作为最早开发机器人肝胆项目的中心之一，随着机器人使用量的增加，我们的经验也在不断提高，结果也越来越好。在此，我们介绍我们 10 年来进行大型机器人肝切除术的经验和结果。
2012 年至 2022 年，我们共进行了 361 例机器人肝手术，其中包括 100 例大型肝切除术。对电子病历进行回顾性数据分析，评估机器人大型肝切除术后的结果。比较前 50 例（A 组）和后 50 例（B 组）的结果，以确定实践中的任何改进。分析人口统计学和临床结果变量。评估数据是否正态分布，适当采用 Wilcoxon 秩和检验、卡方检验和逻辑回归模型进行分析。使用 Stata v.17，显著性水平设为 p <.05。
两组的中位手术时间（258 分钟与 256 分钟）、出血量（500 毫升与 500 毫升）、中位住院时间（5 天与 3.5 天）、90 天再入院率（14%与 24%）、主要并发症发生率（14%与 20%）和 90 天死亡率（6%与 4%）均无显著差异。B 组的 ICU 入院率和中转率明显更低（14.0%与 48.0%），而难度指数更高（82%与 58%）。
随着时间的推移，开发具有良好结果的机器人肝项目是可行的。我们的数据表明，我们机构的机器人大型肝切除术学习曲线在大约 50 例时趋于平稳。
