Department of Surgery and Oncology, The Royal Marsden Hospital, 203 Fulham Road, London, SW3 6JJ, UK.
Imperial College London, Exhibition Road, South Kensington, London, SW7 2BU, UK.
Surg Endosc. 2024 Aug;38(8):4329-4335. doi: 10.1007/s00464-024-10913-9. Epub 2024 Jun 14.
Liver surgery is associated with a significant hospital stay regardless the type of liver resection. A large incision is essential for open liver surgery which is a major factor in the course of the patient's recovery. For patients with small parenchyma liver lesions requiring surgical resection, robotic surgery potentially offers the opportunity to transform the patient's post-operative course. A day-case robotic liver resection pathway was formulated and implemented at our institution when patients were planned for discharge within 24 h of admission for liver surgery.
Single surgeon case series of cases performed at a tertiary hepatobiliary and pancreatic centre between September 2022 and November 2023. The inclusion criteria were non-anatomical wedge resections, < 2 anatomical segmental resections, left lateral hepatectomy and minimally invasive surgery.
This is the first series of robotic day-case minor liver resection in the United Kingdom. 20 patients were included in this case series. The mean operative time was 86.6 ± 30.9 min and mean console time was 58.6 ± 24.5 min. Thirteen patients (65%) were discharged within 24 h of surgery. The main cause of hospitalisation beyond 24 h was inadequate pain relief. There were no Clavien-Dindo grade III or above complications, no 30-day readmission and 90-day mortalities.
This case series demonstrates that robotic day-case liver resection is safe and feasible. Robust follow-up pathways must be in place to allow for the safe implementation of this approach, to monitor for any complications and to allow intervention as required in a timely manner.
无论采用哪种肝切除术式，肝外科都与显著的住院时间相关。开放性肝手术需要大切口，这是患者康复过程中的一个主要因素。对于需要手术切除的小肝实质病变患者，机器人手术可能为改变患者术后进程提供机会。当计划在入院 24 小时内出院的肝外科患者采用该方案时，我们机构制定并实施了日间机器人肝切除术路径。
这是一家三级肝胆胰中心的单外科医生病例系列研究，纳入了 2022 年 9 月至 2023 年 11 月期间进行的病例。纳入标准为非解剖性楔形切除术、<2 个解剖性节段切除术、左外侧肝切除术和微创手术。
这是英国首例机器人日间小肝切除术系列研究。该病例系列纳入了 20 例患者。平均手术时间为 86.6±30.9 分钟，平均控制台时间为 58.6±24.5 分钟。13 例（65%）患者在术后 24 小时内出院。住院时间超过 24 小时的主要原因是疼痛缓解不足。无 Clavien-Dindo 分级 III 级或以上并发症、30 天再入院和 90 天死亡率。
该病例系列表明机器人日间肝切除术是安全可行的。必须建立健全的随访途径，以确保安全实施这种方法，监测任何并发症，并在需要时及时进行干预。
