Fujikawa Takahisa, Uemoto Yusuke
Surgery, Kokura Memorial Hospital, Kitakyushu, JPN.
Cureus. 2024 Oct 15;16(10):e71537. doi: 10.7759/cureus.71537. eCollection 2024 Oct.
Introduction Anatomical hepatectomy for segment 7 (S7) lesions is technically challenging due to their restricted accessibility and close proximity to the right hepatic vein, and the robotic approach for this challenging situation is currently not supported by conclusive data. Methods We present our novel technique of robotic anatomical hepatectomy for S7 lesions utilizing the saline-linked cautery (SLiC) method. Between 2022 and 2023, 10 robotic S7 subsectionectomy or right posterior sectionectomy were performed and included in the current study. The historical control group included patients undergoing laparoscopic anatomical hepatectomy for S7 lesions between 2017 and 2021 (n=9). Surgical outcomes were compared between the groups to assess the efficacy and safety of our technical robotic approach for S7 lesions. Results There were no conversions to open liver resection, no cases of grade B or C post-hepatectomy liver failure, and no mortality in the whole cohort. Although no difference was found between the laparoscopic and robotic groups in the difficulty score, operative time, and rate of red blood cell transfusion, the robotic group had a significantly lesser amount of surgical blood loss (28mL vs. 280mL, p=0.005). Concerning postoperative complications, one patient had liver subcapsular hematoma in the robotic group, although neither bile leakage nor intraperitoneal abscess occurred in the whole cohort. Conclusions Although robotic right posterior sectionectomy and S7 subsectionectomy of the liver are technically demanding procedures, the intrahepatic Glissonean approach using the SLiC method is safe and feasible. It might be performed without increasing the incidence of postoperative complications. Thus, the current approach can be considered as one of the preferred options for robotic anatomical hepatectomy for S7 lesions.
引言 由于肝段7（S7）病变位置较深且靠近肝右静脉，解剖性肝切除术技术难度较大，目前尚无确凿数据支持机器人手术用于这种具有挑战性的情况。方法 我们介绍了一种利用盐水连接电灼（SLiC）方法对S7病变进行机器人解剖性肝切除术的新技术。2022年至2023年期间，我们进行了10例机器人S7亚段切除术或右后段切除术，并纳入本研究。历史对照组包括2017年至2021年期间接受腹腔镜S7病变解剖性肝切除术的患者（n = 9）。比较两组的手术结果，以评估我们的机器人技术用于S7病变的有效性和安全性。结果 全组均无中转开腹肝切除术，无B级或C级肝切除术后肝功能衰竭病例，无死亡病例。虽然腹腔镜组和机器人组在难度评分、手术时间和红细胞输血率方面没有差异，但机器人组的手术失血量明显较少（28mL对280mL，p = 0.005）。关于术后并发症，机器人组有1例患者发生肝包膜下血肿，全组均未发生胆漏或腹腔脓肿。结论 虽然机器人肝右后段切除术和S7亚段切除术技术要求较高，但使用SLiC方法的肝内Glissonean入路是安全可行的。它可能在不增加术后并发症发生率的情况下进行。因此，目前的方法可被视为机器人解剖性肝切除术治疗S7病变的首选方案之一。
