Division of Transplant Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
Division of Transplant Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
Am J Transplant. 2024 Aug;24(8):1467-1472. doi: 10.1016/j.ajt.2024.03.030. Epub 2024 Mar 29.
The use of robotic surgery in transplantation is increasing; however, robotic liver transplantation (RLT) remains a challenging undertaking. To our knowledge, this is a report of the first RLT in North America and the first RLT using a whole graft from a deceased donor in the world. This paper describes the preparation leading to the RLT and the surgical technique of the operation. The operation was performed in a 62-year-old man with hepatitis C cirrhosis and hepatocellular carcinoma with a native Model for End-Stage Liver Disease score of 10. The total console time for the operation was 8 hours 30 minutes, and the transplant hepatectomy took 3 hours 30 minutes. Warm ischemia time was 77 minutes. Biliary reconstruction was performed in a primary end-to-end fashion and took 19 minutes to complete. The patient had an uneventful recovery without early allograft dysfunction or surgical complications and continues to do well after 6-months follow-up. This paper demonstrates the feasibility of this operation in highly selected patients with chronic liver disease. Additional experience is required to fully understand the role of RLT in the future of transplant surgery. Narrated video is available at https://youtu.be/TkjDwLryd3I.
机器人手术在移植中的应用正在增加；然而，机器人肝移植（RLT）仍然是一项具有挑战性的任务。据我们所知，这是北美首例 RLT 的报告，也是世界上首例使用已故供体全移植物进行的 RLT。本文介绍了为 RLT 所做的准备工作以及手术操作的技术。该手术在一名 62 岁的男性中进行，该男性患有丙型肝炎肝硬化和肝细胞癌，其原发性终末期肝病模型评分（Model for End-Stage Liver Disease，MELD）为 10 分。手术的控制台总时间为 8 小时 30 分钟，肝移植切除术用时 3 小时 30 分钟。热缺血时间为 77 分钟。胆管重建采用端对端的方式，耗时 19 分钟完成。患者术后恢复顺利，无早期移植物功能障碍或手术并发症，随访 6 个月后仍状况良好。本文证明了在患有慢性肝病的高度选择患者中进行该手术的可行性。需要更多的经验来全面了解 RLT 在未来移植手术中的作用。解说视频可在 https://youtu.be/TkjDwLryd3I 观看。
