Fujikawa Takahisa, Uemoto Yusuke, Harada Kei, Matsuoka Taisuke
Surgery, Kokura Memorial Hospital, Kitakyushu, JPN.
Cureus. 2024 May 9;16(5):e59944. doi: 10.7759/cureus.59944. eCollection 2024 May.
Background Although various types of adhesion barriers are widely utilized in liver surgery, the safety and feasibility of their use during repeat robotic liver resection (R-RLR) are still unknown. Methods Among the 68 patients undergoing RLR with the application of the spray-type adhesion barrier at Kokura Memorial Hospital, Kitakyushu, Japan, between 2021 and 2023, 24 cases that underwent R-RLR were included in this study. The included patients were divided into two groups: those who underwent previous hepatectomy with the use of a spray-type adhesion barrier (R-RLR-B, n = 14) and those without its previous use (R-RLR-NB, n = 10). The perioperative outcomes were compared between the groups. Results There were no differences between the R-RLR-B and R-RLR-NB groups in background characteristics, difficulty scores, operative and console time, or surgical blood loss. Although no difference was found between the groups in the time required for adhesiolysis before the robotic operation, both the time required for robotic adhesiolysis (75 minutes vs. 58 minutes, p = 0.034) and total time for adhesiolysis (192 minutes vs. 141 minutes, p = 0.014) were significantly shorter in the R-RLR-B group than in the R-RLR-NB group. Otherwise, there was no conversion to open hepatectomy, no intraoperative transfusion of red blood cells, no cases of grade B or C post-hepatectomy liver failure, and no mortality in the whole cohort. Conclusions The spray-type adhesion barrier may not be associated with an increase in the incidence of postoperative complications, including bile leakage or intraperitoneal abscess. In addition, its application during the previous hepatectomy can facilitate a secure R-RLR with reduced time for adhesiolysis. Thus, the use of the spray-type adhesion barrier for R-RLR is safe, effective, and time efficient.
尽管各种类型的粘连屏障在肝脏手术中被广泛应用，但其在重复机器人肝脏切除术（R-RLR）中使用的安全性和可行性仍不明确。方法：在2021年至2023年期间，日本北九州市小仓纪念医院68例行RLR并应用喷雾型粘连屏障的患者中，24例行R-RLR的患者纳入本研究。纳入患者分为两组：既往肝切除术使用喷雾型粘连屏障的患者（R-RLR-B组，n = 14）和未使用过的患者（R-RLR-NB组，n = 10）。比较两组围手术期结果。结果：R-RLR-B组和R-RLR-NB组在背景特征、难度评分、手术和控制台时间或手术失血量方面无差异。尽管两组在机器人手术前粘连松解所需时间上无差异，但R-RLR-B组机器人粘连松解所需时间（75分钟对58分钟，p = 0.034）和粘连松解总时间（192分钟对141分钟，p = 0.014）均显著短于R-RLR-NB组。此外，整个队列中无转为开腹肝切除术的情况，无术中输注红细胞的情况，无B级或C级肝切除术后肝衰竭病例，也无死亡病例。结论：喷雾型粘连屏障可能与术后并发症（包括胆漏或腹腔脓肿）发生率的增加无关。此外，其在前次肝切除术中的应用可促进安全的R-RLR，减少粘连松解时间。因此，喷雾型粘连屏障用于R-RLR是安全、有效且省时的。
