Fujikawa Takahisa, Uemoto Yusuke, Harada Kei, Matsuoka Taisuke
Surgery, Kokura Memorial Hospital, Kitakyushu, JPN.
Cureus. 2024 Mar 29;16(3):e57219. doi: 10.7759/cureus.57219. eCollection 2024 Mar.
Introduction While there are several advantages to utilizing robotics in liver surgery compared to traditional open and laparoscopic approaches, the most challenging part of robotic liver resection (RLR) remains the liver parenchymal transection. This is primarily due to the constraints of the existing robotic tools and the absence of a standard procedure. This study presents detailed technical aspects of our novel saline-linked cautery (SLiC) method for RLR and assesses the short-term outcomes for both non-anatomical and anatomical RLRs. Methods In this study, 82 cases that underwent RLR utilizing the SLiC method at our hospital from September 2021 to December 2023 were examined. A novel SLiC method is introduced in this study for robotically transecting the liver parenchyma utilizing bipolar cautery or monopolar scissors. The technique involves activating the SLiC and robotic suctioning simultaneously. The included patients were divided into two groups: patients undergoing robotic anatomical hepatectomy (n=39), and those receiving robotic non-anatomical hepatectomy (n=43). Short-term outcomes, including intraoperative and postoperative complications, were assessed in patients receiving both anatomical and non-anatomical hepatectomies. Results In the whole cohort, 74% of patients had performance status 1 or 2, and 24% were classified as Child-Pugh class B. RLR was performed without Pringle's maneuver in more than 80% of cases in patients receiving robotic non-anatomical hepatectomy, and more than 80% of patients undergoing robotic anatomical hepatectomy required only four or fewer 15-minute Pringle's maneuvers. There was no conversion to open hepatectomy, no cases of grade B or C post-hepatectomy liver failure, and no mortality in the entire cohort. Four postoperative complications with CDC IIIa or higher occurred (small bowel obstruction in two cases, intraabdominal hemorrhage in one, and bile leak in another), but no differences in the frequency of complications were found between those undergoing non-anatomical and anatomical hepatectomy (p=0.342). Conclusions The SLiC method, which involves simultaneously activating SLiC and robotic suctioning with either monopolar scissors or bipolar cautery, appears to be a secure and convenient technique for liver parenchymal transection in RLR. This innovative method permits precise access to the major Glissonean and venous structures within the liver, making RLR more standardized and easily applicable in routine patient care.
引言 与传统的开放手术和腹腔镜手术相比，在肝脏手术中使用机器人技术有诸多优势，然而机器人肝切除术（RLR）最具挑战性的部分仍是肝实质离断。这主要归因于现有机器人工具的限制以及缺乏标准操作流程。本研究介绍了我们用于RLR的新型盐水连接电灼术（SLiC）方法的详细技术细节，并评估了非解剖性和解剖性RLR的短期结果。方法 在本研究中，对2021年9月至2023年12月在我院采用SLiC方法进行RLR的82例病例进行了检查。本研究引入了一种新型SLiC方法，用于通过双极电灼或单极剪刀以机器人方式离断肝实质。该技术包括同时激活SLiC和机器人吸引。纳入的患者分为两组：接受机器人解剖性肝切除术的患者（n = 39）和接受机器人非解剖性肝切除术的患者（n = 43）。对接受解剖性和非解剖性肝切除术的患者评估短期结果，包括术中及术后并发症。结果 在整个队列中，74%的患者表现状态为1或2，24%被归类为Child-Pugh B级。接受机器人非解剖性肝切除术的患者中，超过80%的病例在无Pringle手法的情况下进行了RLR，接受机器人解剖性肝切除术的患者中，超过80%的患者仅需要进行四次或更少的15分钟Pringle手法。整个队列中没有转为开放肝切除术的情况，没有发生B级或C级肝切除术后肝功能衰竭病例，也没有死亡病例。发生了4例美国疾病控制与预防中心（CDC）IIIa级或更高等级的术后并发症（2例小肠梗阻、1例腹腔内出血、1例胆漏），但非解剖性和解剖性肝切除术患者之间的并发症发生率没有差异（p = 0.342）。结论 涉及同时用单极剪刀或双极电灼激活SLiC和机器人吸引的SLiC方法，似乎是RLR中肝实质离断的一种安全且便捷的技术。这种创新方法允许精确进入肝脏内主要的Glissonean结构和静脉结构，使RLR更标准化且易于应用于常规患者护理。
